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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical Cancer
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About the NCCN Guidelines for Patients®
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Comprehensive Cancer Network® (NCCN®).
Cancer care is always changing. NCCN develops
evidence-based cancer care recommendations used by health care providers
worldwide. These frequently updated recommendations are the NCCN Clinical
Practice Guidelines in Oncology (NCCN Guidelines®). The NCCN Guidelines for
Patients plainly explain these expert recommendations for people with cancer
and caregivers.
These NCCN Guidelines for Patients are based on the NCCN
Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
for Cervical Cancer, Version 1.2024 – September 20, 2023.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical Cancer
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical Cancer
Contents
© 2023 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN
Guidelines for Patients and illustrations herein may not be reproduced in any form for
any purpose without the express written permission of NCCN. No one, including doctors
or patients, may use the NCCN Guidelines for Patients for any commercial purpose
and may not claim, represent, or imply that the NCCN Guidelines for Patients that have
been modied in any manner are derived from, based on, related to, or arise out of the
NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be
redened as often as new signicant data become available. NCCN makes no warranties
of any kind whatsoever regarding its content, use, or application and disclaims any
responsibility for its application or use in any way.
NCCN Foundation seeks to support the millions of patients and their families aected
by a cancer diagnosis by funding and distributing NCCN Guidelines for Patients. NCCN
Foundation is also committed to advancing cancer treatment by funding the nation’s
promising doctors at the center of innovation in cancer research. For more details and the
full library of patient and caregiver resources, visit NCCN.org/patients.
National Comprehensive Cancer Network (NCCN) and NCCN Foundation
3025 Chemical Road, Suite 100, Plymouth Meeting, PA 19462 USA
4 Cervical cancer basics
10 Testing and staging
31 Types of treatment
41 Treatment for common types
54 Treatment for neuroendocrine carcinoma of the cervix
58 Survivorship
65 Making treatment decisions
73 Words to know
76 NCCN Contributors
77 NCCN Cancer Centers
80 Index
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical cancer basics » The cervix
Cervical cancer is a common
cancer of the female reproductive
system. Most cervical cancers
are caused by long-term infection
with human papillomavirus (HPV).
HPV is the most common sexually
transmitted infection. The use of
Pap smears has resulted in much
lower rates of cervical cancer in
the United States.
The cervix
The cervix is the narrow, lower end of the
uterus. The uterus is where a baby grows and
develops before being born. During birth, the
cervix opens (dilates) and thins (eaces) to
allow the baby to move into the vagina. The
vagina, or birth canal, is the muscular passage
through which babies are born.
An ovary and a fallopian tube are on each side
of the upper uterus. The fallopian tubes connect
to the top part of the uterus. The ovaries make
eggs for sexual reproduction. They also make
hormones that aect breast growth, body
shape, and the menstrual cycle. Eggs pass out
of the ovary and travel through the attached
fallopian tube into the uterus. The cervix, uterus,
vagina, ovaries, and fallopian tubes are part of
the female reproductive system.
The female reproductive
system
The reproductive system is
a group of organs that work
together for the purpose of
sexual reproduction. In addition
to the uterus (and cervix), this
system includes the ovaries,
fallopian tubes, and vagina.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical cancer basics » The cervix
Most cervical cancers start in the thin layer of
tissue that lines the outer part and inner parts
of the cervix.
The ectocervix is the outer part of the cervix.
It appears rounded and extends into the
vagina. The ectocervix can be seen during an
examination of the vagina and cervix using
a tool called a speculum. It is lined with cells
called squamous cells. In the center of the
ectocervix is a narrow opening called the
external os. During menstruation, the external
os opens slightly to allow blood to pass into
the vagina.
The endocervix (endocervical canal) is the
inner part of the cervix that forms a canal
between the vagina and the body of the
uterus. The endocervix is lined with columnar
(glandular) cells that make mucus. The inner
os is the upper part of the endocervix that
serves as an opening between the uterus and
the cervix.
The area where the endocervix and ectocervix
meet is called the squamo-columnar junction
or the transformation zone. Most cervical
cancers and pre-cancers start in the ectocervix
portion of the transformation zone.
The cervical stroma is the thick layer of
muscular tissue beneath the cervical lining.
The parametrium is the fat and connective
tissue that surrounds the uterus (and cervix)
and connects it to the pelvis.
Although the cervix is part of the uterus,
uterine cancer is diagnosed and treated
dierently than cervical cancer. This patient
guide does not discuss treatment of uterine
cancers, such as endometrial cancer and
uterine sarcomas.
The cervix
Most cervical cancers start in
the area where the inner and
outer cervix meet, called the
squamo-columnar junction.
Specically, most form in
squamous cells that line the
ectocervix part of the squamo-
columnar junction.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Cervical cancer basics » Cervical changes
Cervical changes
Cervical cancer starts as areas of abnormal,
microscopic cells on the surface of the
cervix. These changes are known as cervical
dysplasia or cervical intraepithelial neoplasia
(CIN). Mutations (changes) in the DNA of
these cells cause them to become abnormal. If
left untreated, cervical dysplasia may become
cervical cancer.
CIN is graded based on the depth of the
abnormal cells on the lining of the cervix.
The possible grades are 1, 2, or 3. Cervical
dysplasia becomes cancer when the abnormal
cells invade the muscular tissue beneath the
cervical lining (the cervical stroma).
An area of dysplasia or cancer is also
referred to as a lesion. Low-grade squamous
intraepithelial lesion (LSIL) refers to mild
dysplasia (CIN 1). High-grade squamous
intraepithelial lesion (HSIL) refers to moderate
or severe dysplasia (CIN 2 and 3). HSIL is
considered a pre-cancer.
Cervical changes
Cervical dysplasia refers to areas of abnormal cells on the lining of the cervix. Low-
grade squamous intraepithelial lesion (LSIL) refers to mild dysplasia (CIN 1). High-grade
squamous intraepithelial lesion (HSIL) refers to moderate or severe dysplasia (CIN 2 and
3). HSIL is considered a pre-cancer.
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Cervical cancer basics » Risk factors
Risk factors
A risk factor is something that increases the
risk of developing a disease. Some people with
no known risk factors may develop cervical
cancer, while others with risk factors may not.
HPV infection
Almost all cervical cancers are caused by
long-term infection with human papillomavirus
(HPV). HPV is an extremely common sexually
transmitted infection (STI). Most sexually
active people have or had HPV at one point.
Most are unaware that they are or were
infected.
In most people, the immune system gets rid of
(“clears”) HPV from the body. In other people,
the virus causes long-term cell changes that
develop into cancer. The progression to cancer
often occurs decades after the initial infection.
Experts are still learning why one person gets
cervical cancer and another does not. Other
types of cancer caused by HPV include anal,
head and neck, penile, vaginal, and vulvar
cancers.
There are more than 100 types (strains) of
HPV. Infection with some strains is more likely
to lead to cancer. High-risk forms include HPV-
16 and HPV-18. Other HPV types can cause
abnormal skin growths, called warts, to form
on the anus, genitals, or other areas of the
body.
A vaccine that protects against 9 dierent
strains of HPV, including the highest-risk
strains, is available in the United States. While
previously only recommended for routine use
in adolescents and young adults, vaccination
is now an option for adults aged 45 and under.
There are two other HPV vaccines available in
other parts of the world. One protects against
HPV-16 and HPV-18 only. The other targets
these and two additional types.
The vaccine works best in younger people
(ideally under age 13) because they are less
likely to have been exposed to HPV. And, while
the vaccine can prevent new HPV infections, it
does not treat existing HPV infections or HPV-
related cancer.
Other risk factors
Other risk factors for cervical cancer are listed
below. Some of these lead to a higher risk
because they either increase the risk of being
exposed to HPV or they weaken the immune
system, which can make it harder for the body
to clear HPV infection.
A history of smoking
Having given birth more than once (called
“high parity” or multiparity)
Oral contraceptive (birth control) use
Being sexually active at an early age
A high number of sexual partners
A history of sexually transmitted infection
Certain autoimmune diseases
A weakened immune system due to
human immunodeciency virus (HIV) or
AIDS, for example
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NCCN Guidelines for Patients®
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Cervical cancer basics » Types of cervical cancer
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Cervical cancer basics » Types of cervical cancer » Key points
Types of cervical cancer
Most cervical cancers start in the ectocervix.
The ectocervix is lined with squamous cells.
Cancer that forms in squamous cells is called
a squamous cell carcinoma.
About 2 out of 10 cervical cancers form in the
endocervical canal. The endocervix is lined
with cells that make mucus. These cells are
referred to as glandular, gland-like, secretory,
or columnar cells. Cancers that form in
glandular cells are called adenocarcinomas.
Less commonly, the cancer may contain both
squamous and adenocarcinoma cells. These
cancers are referred to as adenosquamous
carcinomas. They are sometimes called
“mixed” tumors.
Treatment for squamous cell carcinoma,
adenocarcinoma, and adenosquamous
carcinoma is the focus of Part 4.
The rarest and most aggressive type of
cervical cancer is neuroendocrine carcinoma
of the cervix (NECC). Treatment for small cell
NECC is the focus of Part 5.
This patient guide does not discuss other
types of cervical cancer such as glassy-cell
carcinomas, sarcomas, or other tumor types.
Key points
The cervix
The cervix is the lower part of the uterus
that connects to the vagina.
The ectocervix is the outer part that
extends into the vagina. The endocervix
is the canal between the vagina and the
body of the uterus.
Most cervical cancers and pre-cancers
start in the ectocervix portion of the
transformation zone.
Cervical changes
Cervical cancer starts as areas of
abnormal, microscopic cells on the
surface of the cervix.
These changes are known as cervical
dysplasia or cervical intraepithelial
neoplasia (CIN).
Risk factors
The risk factor most strongly linked with
cervical cancer is long-term infection with
HPV, a common sexually transmitted
infection.
A vaccine that protects against 9 dierent
strains of HPV, including the highest-risk
strains, is available in the United States.
Types of cervical cancer
Squamous cell carcinoma is the
most common type, followed by
adenocarcinoma. Adenosquamous
carcinomas are less common.
Neuroendocrine carcinoma of the cervix
(NECC) is a rare and aggressive type of
cervical cancer.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Testing and staging » Biopsy
Your doctors will make a treatment
plan just for you. First, they will
need to gather information about
the cancer and your general
health. This chapter describes
testing and other care needed to
create your treatment plan.
Biopsy
Cervical biopsy and pathologic
review
A cervical biopsy involves removing small
samples of tissue from the cervix. It is the
most commonly used procedure to diagnose
cervical cancer. Samples may be taken
from the rounded, bottom part of the cervix
(ectocervix) and/or from the endocervical
canal.
The removed tissue is examined by a
specialized doctor called a pathologist. A
pathologist is a doctor who specializes in
evaluating cells and tissues to diagnose
disease. The pathologist looks for abnormal
areas, including areas of cancer or pre-cancer.
The pathologist also determines the type of
cervical cancer, when possible.
Cervical biopsy
A cervical biopsy is the most
commonly used procedure
to diagnose cervical cancer.
A small sample of tissue is
removed from the ectocervix
and/or the endocervix.
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NCCN Guidelines for Patients®
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Testing and staging » Biopsy
Cone biopsy
Cone biopsy can be both a test and a
treatment. It may be used to gather more
information about the extent of the cancer after
a cervical biopsy. It is also a recommended
treatment option for some early cervical
cancers.
Also known as cervical conization, cone biopsy
involves removing a cone-shaped portion of
the cervix. The cone-shaped sample includes
tissue from both the ectocervix and the
endocervical canal. All of the transformation
zone—where the ectocervix and endocervix
meet—is removed. Most cervical cancers start
in this area.
Most commonly, a technique called cold knife
conization (CKC) is used. In this method a
surgical scalpel is used to remove the tissue.
In some cases loop electrosurgical excision
procedure (LEEP) may be performed instead.
In LEEP, a thin loop of electried (heated)
wire is used instead of a scalpel to cut out the
cervical tissue.
After removing the cone-shaped sample of
tissue, your doctor may use a spoon-shaped
tool called a curette to scrape a sample of
tissue from the cervical canal. This is called
endocervical curettage.
The tissue removed during a cone biopsy
is examined under a microscope by a
pathologist.
Cone biopsy
A cone biopsy removes a cone-
shaped section of the cervix that
includes the transformation zone.
Cone biopsy may be the only
treatment needed for some early-
stage cervical cancers.
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Testing and staging » Health history and physical exam
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Testing and staging » Health history and physical exam » Blood tests
Health history and physical
exam
To help plan treatment, expect your doctor
to ask about your past and current health,
including:
Illnesses, diseases, and surgeries
Medicines that you take (prescription or
over-the-counter)
Your lifestyle (your diet, activity level,
whether you smoke or drink alcohol)
Possible symptoms of cervical cancer,
such as watery vaginal discharge
Your doctor will also do a physical exam of
your body, which may include:
Checking your vital signs (blood pressure,
heart rate, breathing rate, and body
temperature) and overall appearance
Feeling and/or listening to the organs in
your abdomen, including your liver and
stomach
A pelvic examination to check the size,
position, and appearance of your cervix
and uterus
It is important to let your doctor know if you
have trouble with pelvic exams due to pain,
anxiety, or other reasons.
Blood tests
The following blood tests may be ordered as
part of initial testing. They can provide helpful
information about your general health and the
health of your liver, kidneys, and other organs
before treatment.
A complete blood count (CBC) is a
common test that measures the number of red
blood cells, white blood cells, and platelets in a
sample of blood. Red blood cells carry oxygen
throughout the body. White blood cells ght
infection. Platelets help to control bleeding.
A blood chemistry prole measures the
levels of dierent chemicals in your blood.
Chemicals in your blood are aected by your
kidneys, bones, and other organs and tissues.
Blood chemistry levels that are too high or too
low may be a sign that an organ is not working
well. Abnormal levels may also be caused by
the spread of cancer or by other diseases.
Liver function tests are often done along
with a blood chemistry prole. The liver is an
organ that does many important jobs, such as
remove toxins from the blood. Liver function
tests measure enzymes that are made or
processed by the liver. Levels that are too high
or too low may be a sign of liver damage or
cancer spread.
If you have not had a recent human
immunodeciency virus (HIV) test, or
have never been tested, your doctor may
recommend it. If you have HIV, you are likely
to be referred to an HIV specialist. Having HIV
should not aect your cancer treatment. The
treatment options described in this guide apply
to both HIV-positive and HIV-negative patients.
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Testing and staging » Imaging
Imaging
Imaging helps determine the extent of the
cancer. The size and spread of the cancer is
used to guide treatment.
Computed tomography
You may have a computed tomography (CT)
scan of your chest, abdomen, and/or pelvis.
A CT scan is a more detailed kind of x-ray. It
takes many pictures of an area inside the body
from dierent angles.
A computer combines the pictures to make
three-dimensional (3-D) images. During the
scan, you will lie face up on a table that moves
through a large tunnel-like machine. To see
everything better, a substance called contrast
may be injected into your vein and also mixed
with a liquid you drink. Contrast makes the CT
pictures clearer. The contrast may cause you
to feel ushed or get hives. You will be able to
hear and talk to the technician at all times. You
may hear buzzing or clicking during the scan.
PET/CT
A CT scan may be combined with another
imaging test called positron emission
tomography (PET). PET uses small amounts of
radioactive materials called radiotracers. About
an hour before the scan, you will be injected
with a sugar radiotracer. The radiotracer gives
o a small amount of energy that can be seen
by the imaging machine. Cancer appears
brighter in the pictures because cancer cells
use sugar more quickly than normal cells.
In some cases, PET may be performed with
magnetic resonance imaging (MRI) (described
next) instead of CT.
MRI
An MRI makes pictures of
areas inside the body without
using radiation. An MRI
can show the tissues of the
uterus, cervix, and vagina in
detail.
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NCCN Guidelines for Patients®
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Testing and staging » Imaging
Magnetic resonance imaging
MRI uses strong magnetic elds and radio
waves to make pictures of areas inside the
body. It is especially good at making clear
pictures of areas of soft tissue. Unlike a CT
scan or x-ray, MRI does not use radiation.
You may have an MRI of your pelvis. An MRI
can show the tissues of the uterus, cervix, and
vagina closely. An MRI may show whether the
cancer has spread to tissues next to the cervix,
such as the parametrium, vagina, bladder, or
rectum.
For those with small cell neuroendocrine
carcinoma of the cervix (NECC), MRI of the
brain is also recommended as part of initial
testing.
Getting an MRI scan is similar to getting a
CT scan. You will lie face-up on a table that
moves through a large tunnel in the scanning
machine. The scan may cause your body to
feel a bit warm. Like a CT scan, a contrast
agent will be used to make the pictures clearer.
MRI scans take longer to complete than CT
scans. The full exam can take an hour or
more. Tell your doctor if you get nervous in
tight spaces.
Transvaginal ultrasound
If you cannot have MRI of your pelvis, you may
have an ultrasound instead. Ultrasound uses
sound waves to make pictures of areas inside
of the body. It is good at showing the size,
shape, and location of the cervix.
In a transvaginal ultrasound, a probe will be
inserted into your vagina. This helps your
doctor see the cervix and nearby areas more
clearly.
Transvaginal ultrasound
Ultrasound uses sound waves
to make pictures of the inside
of the body. For a transvaginal
ultrasound, a probe is inserted
into the vagina. Ultrasounds are
generally painless, but you may
feel some discomfort when the
probe is inserted.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Testing and staging » Fertility and pregnancy
Fertility and pregnancy
If you want the option of becoming pregnant
in the future, talk to your care team about
fertility-sparing treatment. It is typically only
an option for small, early-stage cancers.
Recommendations for fertility-sparing
treatment are provided in Part 4: Treatment for
common types.
If fertility preservation is desired, talk to
your doctor about seeing a reproductive
endocrinologist. Reproductive endocrinologists
are doctors that specialize in fertility. Although
natural pregnancy will not be possible, options
to discuss may include ovarian transposition,
egg or embryo freezing, and consideration of
possible surrogate pregnancy in the future.
Ovarian transposition
Cervical cancer treatment may involve external
beam radiation therapy (EBRT). Radiation
damages the ovaries and causes them to
stop producing hormones needed for natural
pregnancy. Ovarian transposition is a surgery
that moves one or both ovaries out of the
range of the radiation beam. The medical
name for this procedure is oophoropexy.
Ovarian transposition before starting EBRT
may be an option if you are premenopausal
and have the most common type of cervical
cancer, squamous cell carcinoma.
Egg freezing
Unfertilized eggs can be removed, frozen, and
stored for later use. The medical term for this
is oocyte preservation.
Surrogacy
If you have frozen embryos or frozen eggs
(oocytes), you may consider using a surrogate.
A surrogate (often a relative or friend)
volunteers to have the embryos inserted into
their uterus. They carry the pregnancy and
give birth.
For more information on fertility preservation,
see the NCCN Guidelines for Patients:
Adolescent and Young Adult Cancer at
NCCN.org/patientguidelines and on the
NCCN Patient Guides for Cancer app.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Testing and staging » Other testing and care
Other testing and care
Checking the bladder and bowel
Your doctor may want to examine nearby
organs, like the bladder and bowel, for signs
of cancer. If these tests are needed, expect
to receive general anesthesia. This means
you will be fully sedated and unaware that the
procedure is taking place. These are referred
to as examinations under anesthesia (EUAs).
Cystoscopy is a procedure to see inside
the bladder and other organs of the urinary
tract. It is performed using a hollow tool
with a magnifying lens at one end, called
a cystoscope. The cystoscope is inserted
through the urethra and guided into the
bladder.
Proctoscopy is a procedure to see inside the
anus and rectum. It is performed with a thin,
tube-like instrument with a light and magnifying
lens called a proctoscope.
If abnormal or suspicious areas are seen
during cystoscopy or proctoscopy, tissue
samples will be removed and tested (biopsied).
If you smoke or vape, seek
help to quit
If you smoke or vape, it’s important
to quit. Smoking can limit how well
cancer treatment works. Smoking
and vaping can also increase the risk
of lung problems during and after
chemotherapy. They also increase your
chances of developing other cancers.
Nicotine is the chemical in tobacco
that makes you want to keep smoking.
Nicotine withdrawal is challenging for
most people who smoke. The stress of
having cancer may make it even harder
to quit. If you smoke, ask your care
team about resources and programs
that can help you quit.
For online support, try these websites:
• SmokeFree.gov
• BeTobaccoFree.gov
• CDC.gov/tobacco
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Testing and staging » Staging
Staging
The results of imaging and the other testing
just described are used to determine the stage
(extent) of the cancer. Your treatment options
will depend on the cancer stage.
The International Federation of Gynecology
and Obstetrics (FIGO) system is used to stage
cervical cancer. There are four main stages in
the FIGO system: I (1), II (2), III (3), and IV (4).
The stages are broken down into sub-stages
that have letters and may also have a number.
The following information is used to stage the
cancer in the FIGO system:
The size or extent/depth of the tumor
Whether any lymph nodes have cancer
Whether the cancer has spread to involve
nearby organs such as the bladder or
rectum
Whether the cancer has spread to distant
organs such as the liver, lungs, and/or
bone (metastasized)
The stages are explained and pictured on
the following pages. In general, people with
earlier cancer stages have better outcomes,
but not always. Some people will do better
than expected for their stage, and some will do
worse.
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Testing and staging » Staging
Stage 1A cervical cancer
The cancer is 5 millimeters (mm) or smaller. 5 mm is about the size
of a standard pencil eraser. Cancers 3 mm or smaller are stage 1A1.
Cancers between 3 and 5 mm are stage 1A2.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 1B1 cervical cancer
The cancer is larger than 5 mm but smaller than 2 cm.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 1B2 and 1B3 cervical cancer
The cancer is only in the cervix. In stage 1B2, the cancer is
between 2 and 4 cm. In stage 1B3, the cancer is larger than 4
cm.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 2 cervical cancer
The cancer has grown beyond the cervix. If the cancer has grown into the upper
vagina, the stage is 2A. Stage 2A1 cancers are 4 cm or smaller. Stage 2A2
cancers are larger than 4 cm. Stage 2B cancer has grown into the parametrium.
The parametrium is the fat and connective tissue that surrounds the cervix and
uterus.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 3A cervical cancer
The cancer has grown into the lower third of the vagina.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 3B cervical cancer
The cancer has grown into the pelvic wall and/or has caused kidney swelling
or dysfunction.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 3C cervical cancer
There is cancer in lymph nodes near the cervix (pelvic lymph nodes) and/
or in lymph nodes in the abdomen, called the para-aortic lymph nodes.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 4A cervical cancer
The cancer has spread to nearby organs, such as the bladder or rectum.
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NCCN Guidelines for Patients®
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Testing and staging » Staging
Stage 4B cervical cancer
The cancer is metastatic. It has spread to the liver, lungs, abdomen, bone,
or other distant sites or lymph nodes.
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Testing and staging » Cancer care plan
Cancer care plan
Your treatment team
Treatment for cervical cancer often involves
a team of experts, including a gynecologic
oncologist, a medical oncologist, and a
radiation oncologist.
A gynecologic oncologist is an expert in
surgery and chemotherapy for female
reproductive cancers. A medical oncologist
is an expert in treating cancer with
chemotherapy. A radiation oncologist is an
expert in the use of radiation therapy to treat
cancer.
Your primary care physician (PCP) and
gynecologist can also be a part of your team.
These health care providers can help you
express your feelings about your care to the
team. Treatment of other health problems may
be improved if they are aware of and involved
in your cancer care. In addition to doctors, you
may receive care from nurses, social workers,
and other health experts. Ask to have the
names and contact information of your health
care providers included in the treatment plan.
Cancer treatment
There isn't a treatment plan that is best
for everyone. There is often more than
one treatment option, including clinical
trials. Clinical trials study the safety and
eectiveness of investigational treatments.
The treatment that you and your doctors agree
on should be described in the treatment plan.
All known side eects should also be noted. It
is also important to note the goal of treatment
and the chance of a good treatment outcome.
Keep in mind that your treatment plan may
change. Testing may provide new information.
How well the treatment is working may change
the plan. Or you may change your mind about
treatment. Any of these changes may require a
new treatment plan.
Stress and symptom control
Anxiety and depression are common in people
with cancer. At your cancer center, cancer
navigators, social workers, and others can
help. Help may include support groups, talk
therapy, exercising, spending time with loved
ones, or medication.
You may be unemployed or miss work during
treatment. Or, you may have little or no health
insurance. Talk to your treatment team about
work, insurance, or money concerns. They will
include information in the treatment plan to
help you manage the costs of care.
For more information, see the NCCN
Guidelines for Patients: Distress During
Cancer Care at NCCN.org/patientguidelines
and on the NCCN Patient Guides for Cancer
app for more information.
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NCCN Guidelines for Patients®
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Testing and staging » Cancer care plan
Supportive care
Supportive care aims to relieve the symptoms
of cancer or the side eects of cancer
treatment. It can help relieve discomfort and
improve quality of life. Supportive care may be
given alone or with cancer treatment.
Side eects
Managing side eects is a shared eort
between you and your care team. It is
important to speak up about bothersome
side eects, such as nausea and vomiting.
Ask about your options for managing or
relieving the eects of treatment.
More information on nausea and
vomiting is available at NCCN.org/
patientguidelines and on the NCCN
Patient Guides for Cancer app.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Testing and staging » Key points
Key points
Cervical cancer is most often diagnosed
by cervical biopsy. Samples of cervical
tissue are removed and tested for
dysplasia and cancer.
A cone biopsy may be used to gather
more information after a cervical biopsy or
to treat early cervical cancer. It involves
removing a cone-shaped portion of the
cervix.
Blood tests provide helpful information
about your general health and the health
of your liver, kidneys, and other organs
before treatment.
Imaging helps determine the extent of the
cancer before treatment. Initial imaging
may include CT, MRI, PET, and/or
transvaginal ultrasound.
A cystoscopy and/or proctoscopy under
anesthesia may be needed to look for
signs of cancer in the bladder and bowel.
Fertility-sparing treatment may be an
option for cancer that is only in the cervix.
The stage is a rating of the extent of the
cancer before any treatment is given. It is
used to determine your treatment options.
The FIGO system is used to stage
cervical cancer.
Quitting smoking can lead to better
cancer treatment outcomes. Help is
available if you are ready to stop smoking.
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NCCN Guidelines for Patients®
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Types of treatment » Surgery
In this chapter, the main
treatments for cervical cancer are
described. Your treatment options
will depend on the extent of the
cancer and other factors.
Surgery
Surgery is often the main treatment for early-
stage cervical cancer. The types of surgery
that may be used are described below.
Removing only a portion of the cervix may
be an option for the earliest stage of cervical
cancer. In most cases, however, the entire
cervix must be removed. While this can
sometimes be performed through the vagina,
an abdominal incision (cut) is usually needed.
When the surgery is performed through a
traditional (big) incision through the abdomen,
the approach is known as laparotomy.
Minimally invasive (also called laparoscopic)
surgery involves making only a few small
cuts into your body. There is usually less pain
and scarring compared to surgery that uses
a larger cut through the abdomen. The time it
takes to recover is also usually shorter.
Cone biopsy
Cone biopsy involves removing a cone-shaped
section of the cervix that includes tissue from
both the ectocervix and endocervix. It is a
recommended treatment option for some small
cervical cancers. See Part 2: Testing and
staging for more information on cone biopsy.
Trachelectomy
Trachelectomy is surgery to remove the cervix.
The upper part of the vagina and pelvic lymph
nodes may also be removed. Trachelectomy
is a fertility-sparing surgery. The uterus
and ovaries are left intact, allowing for the
possibility of natural pregnancy in the future.
In a simple trachelectomy, only the cervix is
removed. In a radical trachelectomy, about 2
centimeters (less than a half inch) of vaginal
tissue is removed in addition to the cervix.
Both types can be performed either through
the vagina or the abdomen.
Hysterectomy
Hysterectomy is surgery to remove the
uterus (including the cervix). The types of
hysterectomy that may be used to treat
cervical cancer are described below.
An extrafascial (simple) hysterectomy
removes only the uterus (including the cervix).
Extrafascial hysterectomy can be performed
through the vagina, through the abdomen, or
using a minimally invasive approach. This type
is most commonly used for stage IA1 cancer.
A modied radical hysterectomy removes the
uterus (including the cervix), a portion of the
connective tissue that holds the cervix in place,
and about a half inch or less of the vagina.
Modied radical hysterectomy is performed
through the abdomen.
A radical hysterectomy removes the uterus
(including the cervix), much of the connective
tissue that holds the cervix in place, and the
top quarter or third of the vagina. Radical
hysterectomy is performed through the
abdomen.
There are other dierences between these
hysterectomy types. If surgery is planned,
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Types of treatment » Surgery
your surgeon will explain the procedure
recommended for you in detail.
Ovary preservation
The ovaries may or may not be removed
during hysterectomy. If you have not entered
menopause, surgery that removes both ovaries
will cause menopause. This is referred to as
surgical menopause. It is caused by the sudden
drop in estrogen in the body. There are short-
and long-term symptoms and risks of surgical
menopause that can greatly aect quality of
life. When caused by surgery, the symptoms of
menopause may be sudden and more severe.
Symptoms include hot ashes, sleeping
problems, night sweats, weight gain, and
changes in mood. Vaginal atrophy is another
common symptom. Vaginal atrophy is a
condition in which the lining of the vagina
becomes thin, dry, and inamed. Long-
term risks of not having enough estrogen
include cardiovascular disease and bone loss
(osteoporosis).
If hysterectomy is being considered, ask your
doctor if keeping your ovaries is appropriate.
Lymph node dissection
Cancer cells can travel through blood and
lymph. Lymph is a clear uid that carries
infection-ghting white blood cells. Lymph
nodes are bean-shaped glands found
throughout the body. They contain immune cells
that help the body ght infection and disease.
During surgery for cervical cancer, lymph
nodes may be removed in order to be
tested for cancer. This is called lymph node
dissection or lymphadenectomy. In order to
identify and remove the lymph node(s) most
likely to contain cancer, a sentinel lymph
node biopsy may be performed. This
involves injecting a special dye or a radioactive
substance into the cervix near the cancer.
Lymph nodes containing the dye or substance
can be seen using a special camera. These
are the sentinel nodes. They are removed and
tested for cancer.
Testing the removed nodes helps determine
the extent (spread) of the cancer. Removing
lymph nodes can also help limit the spread of
cancer cells through lymph. The closest lymph
nodes to the cervix are the pelvic nodes.
Cervical cancer generally spreads to these
nodes rst. Lymph nodes in the abdomen,
called the para-aortic nodes, are also
sometimes removed.
Pre-treatment surgical staging
If the cancer has spread beyond the cervix, a
hysterectomy is not performed but pelvic and/
or para-aortic lymph nodes may be removed
and tested before any treatment is given.
Knowing whether pelvic or para-aortic nodes
contain cancer can help guide treatment
decisions for more advanced cancers. A
minimally invasive approach is typically used
to access and remove the lymph nodes. This is
referred to as laparoscopic surgical staging.
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NCCN Guidelines for Patients®
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Types of treatment » External beam radiation therapy
External beam radiation
therapy
Radiation therapy uses high-energy waves
similar to x-rays to kill cancer cells. In external
beam radiation therapy (EBRT), a large
machine aims radiation at the cancer site. The
radiation passes through skin and other tissue
to reach the tumor and nearby lymph nodes.
EBRT is given in small doses, called fractions.
An advanced type of EBRT called intensity-
modulated radiation therapy (IMRT) is often
used to treat cervical cancer. IMRT uses
many small beams of dierent strengths. This
allows a high dose of radiation to reach the
tumor while limiting the amount of radiation
to the surrounding normal tissue. With IMRT
it is possible to reduce radiation to important
nearby organs and structures, such as the
bowel, bladder, external genitalia, and hip
joints. This can help reduce treatment-related
side eects.
Stereotactic body radiation therapy (SBRT)
is a highly specialized type of EBRT used to
treat metastatic cervical cancer. High doses of
radiation are delivered to tumors in the liver,
lungs, or bone using very precise beams.
Treatment is typically delivered in 5 or fewer
sessions.
Side effects
Common side eects during the 5 to 6 weeks
of EBRT include fatigue, skin redness and
irritation, diarrhea, nausea, and frequent or
painful urination. Most of these side eects
develop gradually. They increase during
treatment and gradually decrease once
treatment is over.
When the ovaries are included in the radiation
eld, it causes premature (early) menopause.
The symptoms are similar to those caused
by surgical menopause, as described above.
Ovarian transposition is a surgery that moves
one or both ovaries out of the range of the
External beam radiation
therapy
A large machine aims
radiation at the tumor, passing
through skin and other tissue
to reach it.
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Types of treatment » Chemoradiation
radiation beam. This procedure may be an
option if you are premenopausal and have
the most common type of cervical cancer,
squamous cell carcinoma.
Otherwise, your doctor may consider the
use of menopausal hormone therapy (MHT)
after radiation therapy has completed.
This approach used to be called hormone
replacement therapy or HRT. Hormone therapy
for menopause helps lessen some of the side
eects of radiation-induced menopause. See
Part 6: Survivorship for more information.
Radiation therapy for cervical cancer can also
have long-term and serious side eects on
fertility, sexual health, and bowel and bladder
function.
What to expect
A planning session, called simulation, is
needed before EBRT begins. You will rst be
placed in the treatment position. You will be
asked to lie on your back and stay very still.
You may get tted for a prop to help you stay
still during the radiation sessions.
Pictures of the cancer site(s) will be obtained
with a CT scan. Using the CT images and
sophisticated computer software, your
radiation oncologist will make a treatment plan.
The plan will specify the radiation dose(s)
and the number of sessions you will need.
There will be several days between the time of
simulation and the beginning of your treatment
sessions. This allows sucient time for careful
treatment planning, dose calculation, and
quality assurance.
During treatment, you will lie on a table as
you did for simulation. Devices may be used
to keep you from moving. This helps to target
the tumor. Ink marks (tattoos) on your skin will
help position your body accurately for daily
treatments. The technician will be operating
the machine from an adjacent room. You will
be able to see, hear, and speak with them at
all times. You will not see, hear, or feel the
radiation. One session can take less than 10
minutes.
Chemoradiation
EBRT and chemotherapy are often used
together to treat cervical cancer. They
are given concurrently (during the same
time period) in a treatment strategy
called chemoradiation. Chemoradiation is
recommended for most locally advanced
cervical cancers. These cancers have grown
beyond the cervix but have not spread to the
liver, lungs, or bones.
As part of chemoradiation, there are typically 5
EBRT treatment sessions per week for 5 to 6
weeks. Chemotherapy is typically given once
weekly during this time. See page 37 for more
information on chemotherapy.
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NCCN Guidelines for Patients®
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Types of treatment » Brachytherapy
Brachytherapy
Also known as internal radiation therapy,
brachytherapy involves treatment with
radioactive material placed inside the body.
Brachytherapy allows a high dose of radiation
to be targeted at the tumor while limiting the
amount delivered to surrounding normal tissue.
During brachytherapy, instruments are
placed into the cervix, uterus, and vagina.
A radioactive material then travels into the
instruments that have been placed in the
body. This method is known as intracavitary
brachytherapy. Sometimes, additional
instruments (catheters, or thin hollow tubes)
are placed in the tumor itself or in tissues next
to the tumor (interstitial brachytherapy). For
the treatment of cervical cancer, intracavitary
brachytherapy is most often used. Interstitial
brachytherapy is a specialized technique
that is used for more advanced cancers that
involve the parametrium. It is best performed
at cancer centers with experience in this
method.
Brachytherapy for cervical cancer may be
given in short bursts, called high dose-rate
(HDR) brachytherapy, or in long bursts, called
low dose-rate (LDR) brachytherapy. Most
centers currently use HDR brachytherapy.
Treatment is typically given in 3 to 5 sessions
over 2 weeks.
If you have not had a hysterectomy, a device
called an applicator is inserted into the
uterus through the vagina. A “tandem and
ring” applicator is commonly used for HDR
brachytherapy. The tandem is a long, thin
tube that extends into the uterus. The ring is a
hollow circle that stays in the vagina, pressed
against the cervix. A tandem and ovoid
applicator uses hollow, rounded capsules
instead of a ring. General anesthesia or deep
sedation is often required, especially for the
rst applicator placement.
The applicator is placed to align with the
tissue targeted for treatment. Often, an
imaging technique (MRI or CT) is used to
guide placement of the applicator. These
images are used to design the brachytherapy
treatment plan. The applicator is connected to
a brachytherapy machine. A radiation source
travels from the machine through the hollow
tubes and into the applicator. Treatment takes
about 10 minutes.
Sometimes brachytherapy is given as
treatments over a couple days. In this case,
the instruments are placed and left in the body
until all the treatments have been given (1 to
2 days). You will need to remain in bed until
treatment is complete so that the instruments
don’t move.
Brachytherapy is typically started in the nal
week or right after completing EBRT. Shrinking
the tumor with EBRT rst allows for better
placement of the brachytherapy applicators.
Treatment with both types of radiation therapy
can be completed within 7 to 8 weeks.
Side effects
The side eects of brachytherapy are similar to
those of EBRT and include:
Skin irritation near treatment area
Tiredness (fatigue)
Soreness in your pelvic area
Diculty urinating or painful urination
Softer bowel movements or diarrhea
Increased vaginal discharge
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NCCN Guidelines for Patients®
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Types of treatment » Systemic therapy
Systemic therapy
Systemic therapy is treatment with substances
that travel in the bloodstream, reaching cells
throughout the body. Chemotherapy, targeted
therapy, and immunotherapy are types of
systemic therapy.
Most systemic therapies are given
intravenously. This means they are slowly
infused into your bloodstream through a vein.
Infusions are often given in cycles of treatment
days followed by days of rest. This allows your
body to recover between cycles.
Chemotherapy
Platinum-based chemotherapy is the most
commonly used systemic therapy for cervical
cancer. It stops the growth of cancer cells,
either by killing the cells or by stopping them
from dividing.
Cisplatin is generally preferred for platinum-
based chemotherapy. If cisplatin is expected
to be too harsh or cannot be given for other
reasons, a dierent platinum drug called
carboplatin may be used instead.
As part of treatment with chemoradiation,
cisplatin is typically given on a 7-day cycle
(once weekly) for 5 to 6 weeks. When used for
recurrent or metastatic cancer, infusions are
typically given once every 3 weeks.
Targeted therapy and
immunotherapy
Targeted therapy and immunotherapy
are newer types of systemic therapy.
Unlike chemotherapy, targeted therapy
and immunotherapy are most eective at
treating cancers with specic features, called
biomarkers. They may be options for treating
cervical cancer that returns or spreads after
treatment with chemotherapy.
Side effects of systemic therapy
Systemic therapy can kill healthy cells in
addition to cancer cells. The damage to
healthy cells causes potentially harsh side
eects. The side eects of chemotherapy
depend on many factors, including the drug(s),
the dose, and the person. In general, side
eects are caused by the death of fast-growing
cells, which are found in the intestines, mouth,
and blood. As a result, common side eects
include:
Loss of appetite
Nausea
Vomiting
Mouth sores
Hair loss
Fatigue
Increased risk of infection
Bleeding or bruising easily
Nerve damage (neuropathy)
Cisplatin can damage the kidneys. People
whose kidneys do not work well may not
be able to have cisplatin. An alternative
chemotherapy drug may be used. Cisplatin
can also cause ringing in the ears (tinnitus) or
hearing problems or loss.
Ask your treatment team for a list of common
and rare side eects of each systemic therapy
you are receiving. There are ways to prevent
or alleviate some of these eects.
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NCCN Guidelines for Patients®
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Types of treatment » Clinical trials
Clinical trials
A clinical trial is a type of medical research
study. After being developed and tested in
a laboratory, potential new ways of ghting
cancer need to be studied in people. If found
to be safe and eective in a clinical trial, a
drug, device, or treatment approach may
be approved by the U.S. Food and Drug
Administration (FDA).
Everyone with cancer should carefully consider
all of the treatment options available for their
cancer type, including standard treatments and
clinical trials. Talk to your doctor about whether
a clinical trial may make sense for you.
Phases
Most cancer clinical trials focus on treatment.
Treatment trials are done in phases.
Phase 1 trials study the dose, safety, and
side eects of an investigational drug or
treatment approach. They also look for
early signs that the drug or approach is
helpful.
Phase 2 trials study how well the drug or
approach works against a specic type of
cancer.
Phase 3 trials test the drug or approach
against a standard treatment. If the
results are good, it may be approved by
the FDA.
Phase 4 trials study the long-term
safety and benet of an FDA-approved
treatment.
Who can enroll?
Every clinical trial has rules for joining, called
eligibility criteria. The rules may be about age,
cancer type and stage, treatment history, or
general health. These requirements ensure
that participants are alike in specic ways
and that the trial is as safe as possible for the
participants.
Informed consent
Clinical trials are managed by a group of
experts called a research team. The research
team will review the study with you in detail,
including its purpose and the risks and
benets of joining. All of this information is also
provided in an informed consent form. Read
the form carefully and ask questions before
signing it. Take time to discuss it with family,
friends, or others you trust. Keep in mind that
you can leave and seek treatment outside of
the clinical trial at any time.
Start the conversation
Don’t wait for your doctor to bring up clinical
trials. Start the conversation and learn about
all of your treatment options. If you nd a study
that you may be eligible for, ask your treatment
team if you meet the requirements. If you have
already started standard treatment, you may
not be eligible for certain clinical trials. Try
not to be discouraged if you cannot join. New
clinical trials are always becoming available.
Frequently asked questions
There are many myths and misconceptions
surrounding clinical trials. The possible
benets and risks are not well understood by
many with cancer.
Will I get a placebo?
Placebos (inactive versions of real medicines)
are almost never used alone in cancer clinical
trials. It is common to receive either a placebo
with a standard treatment or a new drug with
a standard treatment. You will be informed,
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Types of treatment » Clinical trials
verbally and in writing, if a placebo is part of a
clinical trial before you enroll.
Are clinical trials free?
There is no fee to enroll in a clinical trial. The
study sponsor pays for research-related costs,
including the study drug. You may, however,
have costs indirectly related to the trial, such
as the cost of transportation or child care due
to extra appointments. During the trial, you
will continue to receive standard cancer care.
This care is billed to—and often covered by—
insurance. You are responsible for copays and
any costs for this care that are not covered by
your insurance.
Finding a clinical trial
In the United States
NCCN Cancer Centers
NCCN.org/cancercenters
The National Cancer Institute (NCI)
cancer.gov/about-cancer/treatment/
clinical-trials/search
Worldwide
The U.S. National Library of Medicine
(NLM)
clinicaltrials.gov
Need help nding a clinical trial?
NCI’s Cancer Information Service (CIS)
1.800.4.CANCER (1.800.422.6237)
cancer.gov/contact
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Types of treatment » Key points
Key points
Surgery
Hysterectomy is surgery that removes the
uterus, including the cervix. Some of the
vagina and cervical connective tissue may
also be removed.
The ovaries may be removed or left in
place during hysterectomy. Removing
them causes surgical (premature)
menopause.
Trachelectomy is surgery that removes
the cervix. It is a type of fertility-sparing
surgery. The upper part of the vagina may
also be removed.
Radiation therapy
Radiation therapy uses high-energy
x-rays to kill cancer cells. In EBRT, a large
machine aims radiation at the cancer site.
Brachytherapy involves treatment with
radioactive material placed inside the
body. It delivers a high dose of radiation
directly to the tumor.
Systemic therapy
Platinum-based chemotherapy is the
most commonly used systemic therapy for
cervical cancer.
Targeted therapy and immunotherapy
are most often used for recurrent and/or
metastatic cervical cancer with specic
biomarkers.
Chemoradiation
EBRT and platinum-based chemotherapy
given concurrently (during the same time
period) is a treatment strategy called
chemoradiation.
Clinical trials
Clinical trials give people access to
investigational treatments that may, in
time, be approved by the FDA.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Treatment for common types » Fertility-sparing treatment
This chapter presents
recommended treatment options
for the most common types
of cervical cancer. Surgery is
usually recommended for early-
stage cancers, while most locally
advanced cancers are treated with
chemoradiation.
This section applies to the following types of
cervical cancer:
Squamous cell carcinoma
Adenocarcinoma
Adenosquamous carcinoma
Treatment is based on the cancer stage. The
stage describes how far the cancer has likely
spread based on imaging and other testing.
A risk factor that guides treatment for cervical
cancer is lymphovascular space invasion
(LVSI). LVSI means that there are tumor cells
in the blood vessels or lymph vessels inside
the tumor. Cancers with LVSI are more likely to
spread to nearby lymph nodes. Nearby lymph
nodes are more likely to be removed.
Fertility-sparing treatment
Surgical treatment for early-stage cervical
cancer often involves surgery that removes the
uterus (hysterectomy). Carrying a pregnancy is
not possible after a hysterectomy. If the cancer
has not spread beyond the cervix (stage 1),
fertility-sparing treatment may be an option,
if desired. This approach involves surgery
that does not remove the uterus or ovaries,
allowing you the option of natural pregnancy in
the future.
If fertility-sparing treatment is being
considered, ask your doctor about getting
the opinion of a reproductive endocrinologist.
Reproductive endocrinologists are doctors that
specialize in fertility. A fertility-sparing approach
is not appropriate for some uncommon types
of cervical cancer.
Stage 1A1
Cone biopsy is recommended for stage 1A1
cancers without known LVSI. If the results
are good, no further treatment is needed. If
the results suggest that the cancer was not
completely removed, you may have another
cone biopsy. Or, your doctor may recommend
radical trachelectomy.
For stage 1A1 cancers with LVSI,
treatment with either cone biopsy or radical
trachelectomy is recommended. Pelvic lymph
node evaluation should also be performed. If
trachelectomy is planned, see the next page
for information on treatment after surgery.
Stage 1A2
Cone biopsy is an option for some very-low-
risk stage 1A2 cancers. The tumor must be
smaller than 2 centimeters, there must be no
LVSI, and other criteria must be met. Pelvic
lymph node evaluation is performed in addition
to the cone biopsy.
For stage 1A2 cancers with LVSI,
treatment with either cone biopsy or radical
trachelectomy is recommended. Pelvic
lymph node evaluation is also performed. If
trachelectomy is planned, see the next page
for information on treatment after surgery.
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Treatment for common types » Fertility-sparing treatment
Stage 1B1
Cone biopsy is an option for some very-low-
risk stage 1B1 cancers. The tumor must be
smaller than 2 cm, there must be no LVSI, and
other criteria must be met. Pelvic lymph node
evaluation is also performed.
For stage 1B1 cancers that do not meet the
criteria for cone biopsy, radical trachelectomy
with pelvic lymph node evaluation is
recommended. Lymph nodes in the abdomen
(para-aortic nodes) may be removed in
addition to pelvic lymph nodes.
Stage 1B2
Fertility-sparing surgery is not performed
often for stage 1B2 cancers. Because most
research on fertility-sparing surgery applies to
smaller tumors, abdominal surgery is generally
preferred.
Treatment after surgery
If testing nds no cancer in tissue beyond
the cervix or in lymph nodes removed during
surgery, there are 2 options. External beam
radiation therapy (EBRT) is recommended
for cancers with risk factors. Observation is
recommended for cancers without risk factors.
Your doctor will consider the tumor size,
whether there is LVSI, and other factors when
determining if EBRT is a good choice for you.
If EBRT is planned, platinum chemotherapy
may be given during the same time period.
This is called chemoradiation.
If cancer is found in any pelvic or para-
aortic lymph nodes, or in any tissues outside
the cervix, treatment with chemoradiation is
recommended. Vaginal brachytherapy may
be given in addition to EBRT and platinum
chemotherapy.
Fertility-sparing treatment
Fertility-sparing treatment may
be an option, if desired, for
some stage 1 cancers. This
approach involves surgery that
does not remove the uterus
or ovaries, allowing you the
option of natural pregnancy in
the future.
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Treatment for common types » Early-stage cancer
Early-stage cancer
The treatment options in this section apply to:
Cancers that are only in the cervix
(stage 1)
Cancers that have spread to the upper
vagina (stage 2A)
Surgery is recommended for most early-stage
cancers. Treatment with EBRT alone or with
chemoradiation may be recommended after
surgery.
If you cannot have surgery, radiation
therapy is usually given instead.
Treatment with both external (EBRT)
and internal (brachytherapy) is
recommended.
Options for non–fertility-sparing treatment are
provided next according to stage. EBRT or
chemoradiation may be needed after surgery.
Stage 1A1
Stage 1A1 cancers are typically diagnosed
by cone biopsy. If cancer is found at the
margins (edges) of the removed tissue and
there is no LVSI, you may or may not have
more treatment. If you want the option of
becoming pregnant in the future, the cancer
can often be observed without treatment. For
those who do not want to preserve fertility, an
extrafascial (simple) hysterectomy is usually
recommended. Surveillance will begin.
If cancer or pre-cancer is found in the cone
biopsy margins and surgery is not possible,
brachytherapy is recommended. EBRT may be
given in addition to brachytherapy.
If cancer or pre-cancer is found in the cone
biopsy margins and surgery is possible,
there are two possibilities. Your doctor
may recommend another cone biopsy to
conrm that the cancer is actually stage
1A1. If pre-cancer is found at the margins,
either an extrafascial (simple) hysterectomy
or a modied radical hysterectomy is
recommended. Lymph nodes in the pelvis may
be removed during either type of hysterectomy.
For stage 1A1 cancers with LVSI, modied
radical hysterectomy with lymph node
evaluation is recommended.
Stage 1A2 and 1B1
Extrafascial hysterectomy with lymph node
evaluation is recommended for low-risk stage
1B1 and 1A2 cancers. These cancers must
meet the following criteria for extrafascial
hysterectomy to be considered:
No LVSI
No cancer found in cone biopsy margins
The tumor is any grade squamous
cell carcinoma or a low-grade
adenocarcinoma
The tumor is 2 cm or smaller and not very
deep
No signs of cancer spread in the body
For 1A2 and 1B1 cancers that do not meet
the above criteria, radical hysterectomy with
pelvic lymph node evaluation is recommended.
Lymph nodes in the abdomen (para-aortic
nodes) may be removed in addition to pelvic
lymph nodes.
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Treatment for common types » Early-stage cancer
Stage 1B2 and 2A1
Radical hysterectomy with pelvic lymph node
evaluation is recommended for these stages.
Lymph nodes in the abdomen (para-aortic
nodes) may be removed in addition to pelvic
lymph nodes.
Stage 1B3 and 2A2
Stage 1B3 cancers are larger than 4 cm (about
the size of a walnut) but do not extend beyond
the cervix. Stage 2A2 cancers are also larger
than 4 cm and extend into the upper vagina.
These cancers may be treated as early-
stage (with surgery) or as locally advanced
(with chemoradiation and brachytherapy).
At this time, treatment with chemoradiation
is preferred. See the next page for more
information on this option.
If surgery is planned, radical hysterectomy and
pelvic lymph node dissection is recommended.
Lymph nodes in the abdomen (para-aortic
nodes) may also be removed.
Treatment after surgery
After surgery, the pathologic (surgical) stage
of the cancer is determined by examining the
removed tissue. The following information
applies to the stages below, as determined by
surgery:
Stage 1
Stage 2A
If testing nds no cancer in tissue beyond
the cervix or in lymph nodes removed during
surgery, there are 2 options. External beam
radiation therapy (EBRT) is recommended
for cancers with risk factors. Observation is
recommended for cancers without risk factors.
Your doctor will consider the tumor size,
whether there is LVSI, and other factors when
determining if EBRT is a good choice for you.
If EBRT is planned, platinum chemotherapy
may be given during the same time period.
This is called chemoradiation.
If cancer is found in any pelvic or para-
aortic lymph nodes, or in any tissues outside
the cervix, treatment with chemoradiation is
recommended. Vaginal brachytherapy may
be given in addition to EBRT and platinum
chemotherapy.
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Treatment for common types » Locally advanced cancer
Locally advanced cancer
This section describes treatment options for
cervical cancer that has grown beyond the
cervix but has not spread to the liver, lungs,
or bones. Cancers that are close to spreading
beyond the cervix (stage 1B3) are also
considered locally advanced. Locally advanced
cancers are not metastatic.
The information in this section applies to the
following stages:
Stage 1B3 and 2A2
Stage 2B
Stage 3
Stage 4A
Locally advanced cancers are more likely to
have spread to lymph nodes than early-stage
cancers. Knowing whether lymph nodes in the
pelvis or abdomen contain cancer can help
guide treatment with EBRT for these cancers.
You may have extra imaging to look for lymph
nodes with cancer.
Another approach is to surgically remove
and test lymph nodes before any treatment is
given. A minimally invasive method is typically
used to access and remove the lymph nodes.
This is called surgical staging. If surgical
staging is performed, the para-aortic lymph
nodes are typically removed. Pelvic lymph
nodes may or may not be removed.
Treatment with all of the following is
recommended for most locally advanced
cervical cancers:
Chemoradiation (EBRT and platinum
chemotherapy)
Brachytherapy
If cancer is found in pelvic lymph nodes, EBRT
will include the pelvis. If any para-aortic nodes
are known or suspected to have cancer, EBRT
will be given to a larger treatment area that
includes these nodes as well.
While treatment as described above is
currently preferred for stage 1B3 and 2A2
cancers, surgery is sometimes recommended.
Let us know what
you think!
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complete an online survey
about the
NCCN Guidelines for Patients.
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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Treatment for common types » Surveillance
Surveillance
After nishing treatment, you will have testing
to look for early signs of possible recurrence.
This is known as surveillance. The information
that follows applies to surveillance for common
types of cervical cancer and for small cell
neuroendocrine carcinoma of the cervix
(NECC).
Physical exams
Physical exams performed by your oncologist
are an important part of surveillance,
especially in the rst 5 years after treatment.
At these follow-up visits, tell your doctor about
any changes in your health. Such changes
include new or worsening symptoms and other
health conditions or concerns.
The recommended time frames for these
follow-up visits are as follows:
Years 1 and 2: Every 3 to 6 months
Years 3, 4, and 5: Every 6 to 12 months
After year 5: Once a year or as agreed upon
with your doctor
Time frame ranges are used to allow for
dierences in individual risk of recurrence
and in patient and provider preference. Those
considered at higher risk of recurrence may
benet from more frequent exams than those
with a lower risk.
After the fth year, visits are generally spaced
out to once per year. Or you and your doctor
may agree on a dierent schedule after
discussing your personal risk of recurrence.
Imaging
Unlike physical exams, imaging is generally
not needed at regular intervals for an
extended time after treatment. Imaging is
typically ordered if you have new or worsening
symptoms, or if other ndings suggest
recurrence or spread. Follow-up imaging
is described below according to the cancer
stage.
Stage 1
If you had radiation or chemoradiation
after non–fertility-sparing treatment, or if
the cancer is stage 1B3, you may have a
uorodeoxyglucose (FDG) positron emission
tomography/computed tomography (FDG-
PET/CT) scan 3 to 6 months after nishing
treatment. The area from the neck to the mid-
thigh is typically scanned.
After fertility-sparing treatment, you may have
an MRI of your pelvis (with contrast) 6 months
after surgery and then yearly for 2 to 3 years.
Stages 2, 3, and 4A
Imaging is recommended 3 to 6 months after
treatment for stage 2, 3, and 4A cervical
cancers. An FDG-PET/CT scan is preferred,
but a CT with contrast is also a recommended
option. The area from the neck to the mid-thigh
will be scanned.
Other imaging for these stages may include
a pelvic MRI with contrast 3 to 6 months after
nishing treatment.
Metastatic cancer
For stage 4B or distant recurrences of cervical
cancer, imaging is used mainly to learn how
the cancer is responding to systemic therapy.
Imaging may include CT, MRI, and/or PET/CT.
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Treatment for common types » Recurrence
Pap tests
Depending on the type of surgery you have
(if any), you may have annual Pap screening
tests after treatment. Pap testing is helpful for
nding new areas of abnormal and/or pre-
cancerous cells. It is not as good at detecting
recurrent cervical cancer. Pap testing is also
known as cervical or vaginal cytology.
Blood tests
If you have symptoms, or a physical exam was
suspicious for recurrence, your doctor may
order blood tests.
In addition to a complete blood count (CBC),
testing may measure blood urea nitrogen
(BUN) and creatinine levels. These check your
kidney function. Liver function tests may also
be ordered.
Survivorship
In addition to surveillance testing, a range of
other care is important for cancer survivors.
This includes keeping alert for symptoms of
cancer recurrence. See Part 6: Survivorship for
more information.
Recurrence
This section discusses cervical cancer that
does not improve with treatment (persistent) or
that returns after treatment (recurrent). If your
doctor suspects recurrence based on your
symptoms or a physical exam, you will have
imaging tests to check. This could include CT,
PET, and/or MRI.
Surgery to look inside the body (exploratory
surgery) may be helpful in some cases. The
goal is to learn the extent of the cancer. This
can help guide treatment decisions.
Biomarker testing
Biomarkers are features of a cancer that can
help guide treatment. Biomarkers are often
mutations (changes) in particular genes. They
can also be proteins that are made in response
to the cancer.
Biomarker testing is recommended for all
recurrent cervical cancers. The results help
determine whether treatment with certain
targeted therapies is an option. The results
can also be used to determine whether you
can join certain clinical trials. Some doctors
order biomarker testing early in the course of
treatment. Many doctors wait and order it only
if the cancer returns or spreads.
Testing should be performed on tumor tissue
removed during a biopsy or surgery when
possible. Otherwise, a sample of blood may
be tested instead. Other names for this testing
include molecular testing, tumor proling,
genomic testing, tumor gene testing, next-
generation sequencing (NGS), mutation testing,
and comprehensive genomic proling (CGP).
Testing for PD-L1 expression is
recommended for everyone with recurrent,
progressive, or metastatic cervical cancer. If
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Treatment for common types » Recurrence
the PD-L1 level exceeds a set cuto point,
the cancer is considered PD-L1-positive.
If needed, treatment with certain targeted
therapies or immunotherapies may be an
option for PD-L1–positive tumors.
The biomarkers listed below are less common
in cervical cancer but should still be tested for.
Mismatch repair (MMR)
Microsatellite instability (MSI)
Tumor mutational burden (TMB)
NTRK gene fusion (for those with a
cervical sarcoma)
HER2
RET gene fusion
If cancer returns to the pelvis
Cervical cancer that returns to the pelvis only
is known as a local or regional recurrence. If
the area has not been treated with radiation
and the cancer can be surgically removed,
this is generally preferred. After surgery, EBRT
and systemic therapy are recommended.
Brachytherapy may also be given.
If the area has already been treated with
radiation and it is no longer an option, possible
treatment options are listed below. The best
option(s) for you will depend on the specic
location of the new cancer growth in the pelvis.
Pelvic exenteration surgery
Radical hysterectomy
Brachytherapy
Individualized EBRT and possibly
systemic therapy
Systemic therapy
Resection of new cancer growth
Radical hysterectomy and brachytherapy are
typically only considered in carefully selected
patients. Supportive care is always an option,
whether you are in active treatment or not.
Pelvic exenteration
Pelvic exenteration is a radical surgery that
involves removing multiple organs from the
pelvis. The goal is to cure the cancer by
removing all of the organs to which cancer has
or may spread.
All remaining organs of the female
reproductive system are removed during
pelvic exenteration. This includes the uterus,
fallopian tubes, ovaries, and vagina. Nearby
organs in the pelvis including the bladder,
rectum, and/or anus may also be removed.
If the bladder and/or organs involved in bowel
function are removed, a diversion is typically
performed. Diversions are surgical procedures
that divert (redirect) urine and/or stool to new
openings through which they exit the body.
Vaginal reconstruction
It is often possible to reconstruct the vagina
after pelvic exenteration. A surgeon can
create an articial vagina using muscle from
another area of your body. A muscle in the
lower abdomen called the rectus abdominus
is often used for vaginal reconstruction. This
procedure is sometimes referred to as muscle
ap reconstruction.
If the bladder is removed
An ileal (incontinent) conduit is one type of
urinary diversion. After the bladder is removed,
your surgeon will create a new tube from a
piece of intestine (ileum). This tube will allow
your kidneys to drain. Your urine will now exit
the body through a small opening called a
stoma. A small disposable bag attached to the
outside of your abdomen collects the urine.
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Treatment for common types » Metastatic cancer
This is called an ostomy bag or ostomy pouch.
The bag stays attached to your body with
the help of an adhesive part called a “wafer.”
The wafer sticks to the skin and acts as a
watertight barrier.
Another way urine may be redirected after
removing the bladder is a continent urinary
diversion. It is also referred to as an articial
bladder or “Indiana pouch.” This method uses
a segment of intestine to create a pouch to
hold urine. The pouch has a channel for urine
to pass through made from intestine that
connects it to the wall of the abdomen.
A stoma is made in the abdominal wall at the
location of the reservoir. Sometimes the stoma
can be made in the belly button, making it
less noticeable. To drain urine, a catheter is
inserted into the reservoir several times a day.
A benet to this type of urinary diversion is that
an ostomy bag does not need to be worn on
the outside of the body.
If the rectum is removed
If the rectum is removed, a permanent
colostomy may be created. A colostomy
connects the remaining colon to the outside
of the abdomen. Stool exits the body through
a stoma and goes into a bag attached to the
skin. In some cases, the remaining colon
can be connected to the remaining rectum or
anus and a permanent colostomy may not be
required. You may retain near-normal bowel
function. If the anus is removed during the
surgery, a permanent colostomy is always
needed.
If both the bowel and bladder are removed
If both urinary and fecal diversion are needed,
a double-barreled wet colostomy (DBWC)
is sometimes used. In this technique, only
one opening (stoma) on the surface of the
abdomen is needed. Urine and stool are kept
separate until they exit the body through the
same stoma. Compared to having separate
urinary and fecal diversions, DBWC has been
found to have other benets, such as fewer
leaks.
Metastatic cancer
If left untreated, or if not diagnosed early,
cervical cancer often spreads to the liver,
lungs, and/or bone. Cervical cancer that has
spread to these organs is metastatic. Cancer
that had already metastasized when it was
found is stage 4B. If cancer returns and
metastasizes after treatment, it is known as
a distant recurrence. The information in this
section applies to both types of metastatic
disease.
Metastatic cervical cancer is very hard to cure.
Treatment is usually with systemic therapy.
The goal is to keep the cancer under control
and prevent further spread. If the tumor has
not already been tested for biomarkers, it may
be tested now. Biomarker testing can help
determine whether you may be eligible for
certain targeted therapies or immunotherapies.
It may be possible to remove or destroy the
new cancer growth(s) using one or more of the
treatments listed below.
Resection (surgery)
EBRT
Ablative therapies
Ablative therapies destroy cancerous lesions
with little harm to nearby tissue. They are often
delivered using a specially designed needle (a
probe or electrode) placed directly into or next
to the tumor.
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Treatment for common types » Metastatic cancer
Stereotactic body radiation therapy (SBRT) is
a highly specialized type of EBRT that may be
used to treat tumors in the liver, lungs, or bone.
Only a few treatment sessions are needed.
If treatment with the local therapies listed
above is complete, systemic therapy may
follow.
Systemic therapy
Metastatic cervical cancer is usually treated
with platinum-based chemotherapy. If you had
prior treatment with cisplatin, it may not work
as well again on its own. In this case, it is often
given with 1 or 2 other medicines, as part of a
combination regimen.
A factor your doctor will consider when
selecting a systemic therapy regimen to
use rst (as “rst-line” therapy) is whether
the cancer has the PD-L1 biomarker. At
this time, preferred rst-line regimens for
PD-L1–positive cancers are listed below.
Bevacizumab (Avastin) might be added to
either regimen.
Pembrolizumab (Keytruda) + cisplatin +
paclitaxel
Pembrolizumab (Keytruda) + carboplatin
+ paclitaxel
The preferred rst-line regimen for all other
metastatic cervical cancers is:
Cisplatin + paclitaxel + bevacizumab
Pembrolizumab is an immune checkpoint
inhibitor (a type of immunotherapy).
Bevacizumab is a type of targeted therapy
called a biologic that is designed to work with
chemotherapy.
Other recommended rst-line regimens
include dierent combinations of cisplatin (or
carboplatin), topotecan, paclitaxel, and/or
bevacizumab.
Second-line or beyond
If you cannot have more platinum-based
chemotherapy, there are other options.
Treatment with pembrolizumab (Keytruda) is
preferred for cancers with one of the following
biomarkers:
TMB-H
PD-L1–positive
MSI-H/dMMR
For cancers with a biomarker other than those
listed above, immunotherapy or targeted
therapy may be an option. Biomarkers and
their related systemic therapies are listed in
Guide 1.
For cancers without any of the biomarkers in
Guide 1, preferred options include:
Tisotumab vedotin-tftv (Tivdak), and
Cemiplimab (Libtayo).
If immunotherapy is planned, see the NCCN
Guidelines for Patients for Immunotherapy
Side Eects: Immune Checkpoint Inhibitors at
NCCN.org/patientguidelines and on the NCCN
Patient Guides for Cancer app.
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Treatment for common types » Metastatic cancer
Supportive care
Supportive care is available to everyone
with metastatic cervical cancer, regardless
of whether you are in active treatment.
Supportive care refers to a range of care
and resources often needed by patients with
metastatic cancer. Hospice care, access to
pain specialists, and emotional and spiritual
support are all components of supportive
care. Because metastatic cancer cannot be
cured, the main goal of supportive care is to
make you more comfortable and to help keep
the cancer under control. Supportive care
may also help you live longer and feel better
overall. When used for advanced cancers,
supportive care is often called palliative care.
You may also consider enrolling in a clinical
trial. Ask your treatment team if there is an
open clinical trial that you can join.
Advance care planning
Talking with your doctor about your prognosis
can help with treatment planning. If the cancer
cannot be controlled or cured, a care plan for
the end of life can be made. There are many
benets to advance care planning, including:
Knowing what to expect
Making the most of your time
Lowering the stress of caregivers
Having your wishes followed
Having a better quality of life
Guide 1
Biomarkers and their related treatments
Biomarker Targeted therapy or immunotherapy
PD-L1 positive • Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
MSI-H/dMMR Pembrolizumab (Keytruda)
TMB-H Pembrolizumab (Keytruda)
HER2-positive Fam-trastuzumab deruxtecan-nxki (Enhertu)
RET gene fusion-positive Selpercatinib (Retevmo)
NTRK gene fusion-positive • Larotrectinib (Vitrakvi)
• Entrectinib (Rozlytrek)
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Treatment for common types » Key points
Another part of the planning involves hospice
care. Hospice care does not include treatment
to ght the cancer but rather to reduce
symptoms caused by cancer. Hospice care
may be started because you do not wish to
continue treatment, because no other cancer
treatment is available, or because you are too
sick for treatment.
Hospice care allows you to have the best
quality of life possible. Care is given all day,
every day of the week. You can choose to
have hospice care at home or at a hospice
center. One study found that patients and
caregivers had a better quality of life when
hospice care was started early.
An advance directive describes the treatment
you’d want if you weren’t able to make your
wishes known. It can name a person whom
you’d want to make decisions for you. It is a
legal paper that your doctors have to follow. It
can reveal your wishes about life-sustaining
machines, such as feeding tubes. If you
already have an advance directive, it may
need to be updated to be legally valid.
Key points
Early-stage
Treatment for early-stage cervical cancer
often involves hysterectomy. EBRT or
chemoradiation may follow surgery.
If you cannot have surgery, EBRT and
brachytherapy are recommended.
Fertility-sparing treatment may be
an option for some stage 1 cancers.
Treatment typically involves either cone
biopsy or radical trachelectomy.
Locally advanced
Extra imaging and/or surgical staging may
be done for locally advanced cancers to
see if there is cancer in lymph nodes.
Combined treatment with chemoradiation
and brachytherapy is recommended for
most locally advanced cervical cancers.
Surveillance
Surveillance after treatment involves
physical exams and staying alert for
symptoms of recurrence or spread.
Follow-up imaging is recommended 3 to 6
months after nishing treatment for stage
2, 3, or 4A cancer.
Imaging is generally only ordered if
you have symptoms or there are other
possible signs of relapse.
Recurrence
If you haven’t had treatment with EBRT,
it is likely to be used to treat cancer that
returns to the pelvis.
Pelvic exenteration surgery may be used
to treat recurrent cancer in the pelvis that
cannot be treated with radiation therapy.
Metastatic cancer
Platinum-based chemotherapy is
recommended to treat metastatic
cancer when possible. For cancers
with biomarkers, targeted therapy or
immunotherapy may be an option.
It may be possible to remove or destroy
new cancer growth using resection,
EBRT, and/or ablative treatments.
Supportive care is available to everyone
with cervical cancer.
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Treatment for neuroendocrine carcinoma of the cervix » Early-stage NECC
This chapter presents treatment
options for a rare type of cervical
cancer called neuroendocrine
carcinoma of the cervix (NECC).
Treatment often involves
chemotherapy and both external
and internal radiation therapy.
Surgery may be an option for
small cancers.
The most common type of NECC is small cell.
Treatment for small cell NECC is the focus of
this section.
Treatment often involves chemotherapy, alone
or as part of chemoradiation. The following
regimens are preferred for chemotherapy:
cisplatin + etoposide
carboplatin + etoposide
If you cannot have either of these, there
are other recommended options. For
chemoradiation, cisplatin + etoposide is
preferred. If you cannot have cisplatin,
carboplatin is often used instead.
NECC tumors can contain cells from more
common types of cervical cancer, including
squamous cell carcinoma. If a cancer contains
both NECC cells and cells from a more
common type, the cancer is treated as NECC.
See Part 3: Types of treatment for more
information on the treatments discussed in this
section.
Early-stage NECC
For cancers that have not spread beyond the
cervix, treatment is guided by the size of the
tumor.
Tumors 4 cm or smaller
If you are a candidate for surgery, radical
hysterectomy and pelvic lymph node
dissection are recommended for tumors
4 cm or smaller. Para-aortic lymph nodes
may or may not be removed for testing.
Treatment with either chemotherapy alone or
chemoradiation (chemotherapy and EBRT)
follows surgery.
A second option for tumors 4 cm or smaller is
treatment with chemoradiation (chemotherapy
and EBRT) and brachytherapy. When
treatment is over, your doctor may recommend
additional systemic therapy.
Tumors larger than 4 cm
One option for tumors 4 cm or larger
is treatment with chemoradiation and
brachytherapy rst. More chemotherapy may
follow.
Another possibility is that chemotherapy will
be given rst to try to shrink the cancer. If
chemotherapy works well, surgery (radical
hysterectomy) may be performed. If you have
this surgery, treatment with EBRT alone or
chemoradiation may be given next. More
chemotherapy may follow.
If radical hysterectomy is not performed,
treatment with chemoradiation (EBRT and
chemotherapy) and brachytherapy is the next
step. More chemotherapy may follow.
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Treatment for neuroendocrine carcinoma of the cervix » Locally advanced NECC
Locally advanced NECC
The term "locally advanced" is used to
describe cervical cancer that has grown
beyond the uterus but has not spread to the
liver, lungs, or bone. This includes stage 2,
3, and 4A cancers. Cancers that are close
to spreading beyond the uterus (stage 1B3)
are also considered locally advanced. Locally
advanced cancers are non-metastatic.
At this time, treatment with chemoradiation and
brachytherapy is preferred for locally advanced
NECC. When these treatments are over, you
may have more chemotherapy with the same
regimen.
The other recommended strategy is treatment
with chemotherapy rst, followed by
chemoradiation and brachytherapy.
After initial treatment
If initial treatment works well, surveillance will
begin. Surveillance involves testing to look
for early signs of recurrence. The surveillance
strategy for more common types of cervical
cancer is also recommended for NECC. See
page 47 for information.
If the cancer does not improve with initial
treatment, it is known as “persistent.” Options
for treating persistent NECC that is only in the
pelvis may include:
Systemic therapy
Pelvic exenteration surgery
These are also treatment options for recurrent,
non-metastatic NECC.
If the cancer spreads to the liver, lungs, or
bone (metastasizes), see “Metastatic cancer”
in Part 4: Treatment for common types.
Recommendations for treating metastatic
cancer apply to common cervical cancers and
to NECC.
Supportive care
Supportive care is always an option. This
care is available to everyone with persistent,
recurrent, or metastatic cancer, regardless
of whether you are in active treatment.
Supportive care refers to a range of resources
oered to patients with advanced or metastatic
cancer. Hospice care, access to pain
specialists, and emotional and spiritual support
are all components of supportive care.
Because the cancer cannot be cured, the main
goal of supportive care is to make you more
comfortable and to help keep the cancer under
control. Supportive care may also help you
live longer and feel better overall. When used
for advanced cancers, supportive care is often
called palliative care.
Consider a clinical trial
Enrolling in a clinical trial allows you to receive
treatment while helping researchers learn
more about this rare cancer. Ask your care
team if you qualify for any current clinical trials.
Clinical trials are discussed in more detail at
the end of Part 3: Types of treatment.
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Treatment for neuroendocrine carcinoma of the cervix » Key points
Key points
Small cell NECC is a rare and usually
aggressive (fast-growing) type of cervical
cancer.
Treatment for NECC often involves
chemotherapy, EBRT, and brachytherapy.
Surgery (combined with other treatment)
may also be an option for early-stage
NECC.
Options for treating persistent NECC
that is only in the pelvis include systemic
therapy and possibly pelvic exenteration
surgery.
Supportive care is an option for everyone
with NECC. Talk to your treatment team
about resources available to you.
There is much to be learned about rare
cancers like small cell NECC. Think about
enrolling in a clinical trial for treatment.
We want your
feedback!
Our goal is to provide helpful and
easy-to-understand information
on cancer.
Take our survey to let us know
what we got right and what we
could do better.
NCCN.org/patients/feedback
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Survivorship » Staying alert for recurrence or spread
Survivorship focuses on
the physical, emotional, and
nancial issues unique to cancer
survivors. Survivorship begins at
diagnosis and continues through
treatment, recurrence, and end
of life. Managing the long-term
side eects of having cancer
and making healthy choices are
important parts of survivorship.
During and after cancer treatment, your
primary care physician (PCP), also known as
a general practitioner or family doctor, plays
an important role in your care. Your oncologist
and PCP should work together to make sure
you get the follow-up care you need. Ask your
oncologist for a written survivorship care plan
to be shared with your PCP that includes:
A summary of your cancer treatment
history
A description of possible short-term, late,
and long-term side eects
Recommendations for monitoring for the
return of cancer
Information on when your care will be
transferred to your PCP
Clear roles and responsibilities for both
your cancer care team and your PCP
Recommendations on your overall health
and well-being
Staying alert for recurrence
or spread
Your cancer treatment team and your primary
care doctor will work together to make sure
you get recommended follow-up testing. But
you have one of the biggest responsibilities—
paying close attention to your body. If cervical
cancer does come back, it may aect your
body in ways that you can feel or notice
(symptoms).
Your doctor will teach you about the symptoms
that may mean cervical cancer has returned or
spread. They include:
Vaginal discharge or bleeding
Blood in your urine or stool
Weight loss
Loss of appetite
Pain in the pelvis, hips, back, or legs
Coughing
Shortness of breath
Swelling in your stomach or legs
If you notice any of these
symptoms, contact your doctor
right away. Do not wait for your
next scheduled visit.
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Survivorship » Late and long-term eects
Late and long-term eects
Some side eects of cervical cancer
treatment can start early and linger longer
than expected. Others may not appear until
long after treatment is over. Many cervical
cancer survivors experience changes in bowel,
urinary, and sexual function. More general
eects such as fatigue, trouble breathing, and
diculty sleeping (insomnia) are also common.
The extent and degree of symptoms vary
widely between patients. Ask your treatment
team for a complete list of possible late and
long-term side eects.
Bowel and bladder changes
Urinary incontinence (the inability to hold urine
in the bladder) and urgency (a sudden, strong
need to urinate) are possible after surgery or
radiation therapy for cervical cancer. Watery
and/or frequent bowel movements (diarrhea)
are also possible. Occasional bleeding
may occur either with urination or bowel
movements. Pelvic oor physical therapy,
described next, can help with bowel and
bladder changes.
Ostomy care
If you have an ostomy, you want to join an
ostomy support group. Another option is to
see a health care provider that specializes
in ostomy care, such as an ostomy nurse.
People with ostomies can still live very active
lifestyles. Consider consulting with an ostomy
professional before undertaking vigorous
physical activity.
Pelvic oor physical therapy
The pelvic oor is a group of muscles that
supports the organs of the pelvis. These
muscles play a key role in bowel and bladder
control as well as sexual function and arousal.
There are ways to strengthen these muscles
before and after treatment. This is known as
pelvic oor physical therapy, and there are
health care professionals who specialize in
it. Pelvic oor therapy can include at-home
exercises to tighten and release the vaginal
and anal muscles (Kegel exercises) as well as
hands-on techniques by a physical therapist.
Ask your treatment team for help nding a
pelvic oor specialist in your area.
Infertility and premature
menopause
Surgically removing the ovaries or exposing
them to radiation causes a sudden drop in
estrogen and progesterone. This results
in infertility, and possibly also menopausal
symptoms. These include stopping of periods,
hot ashes, night sweats, weight gain, and
mood changes.
The lining of the vagina can become thin, dry,
and inamed. This is called vaginal atrophy.
Not having enough estrogen can also have
long-term risks, including heart disease and
bone loss (osteoporosis).
When these hormonal changes cause
symptoms of menopause, menopausal
hormone therapy (MHT) may be an option.
This can include systemic (oral or intravenous)
estrogen (combined with progestins for those
with a uterus intact) and vaginal applications
of estrogen. Discussion with a specialized
menopausal symptom team may be helpful to
determine whether this treatment is right for
you.
Vaginal moisturizers
Older age, menopause, and some cervical
cancer treatments can cause the vagina
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Survivorship » Late and long-term eects
to become dry and less stretchy. To oset
this side eect, use of water-based vaginal
moisturizers is highly encouraged. Like
moisturizers for your body, vaginal moisturizers
restore moisture to the vagina and help to
keep the vaginal tissue healthy. Vaginal
moisturizers can be used daily. Many come
with applicators to make using them easier.
Vaginal estrogen cream or tablets may be
particularly helpful where there has been
thinning of the vaginal and vulvar tissues due
to loss of estrogen.
Vaginal dilator therapy
Radiation therapy to the pelvic area can
cause the vagina to become shorter and
narrower. This is called vaginal stenosis.
Vaginal stenosis can make it uncomfortable or
even painful to have sex, or to have vaginal
examinations by a doctor. Vaginal dilator
therapy can be used to lessen the eects of
vaginal stenosis. A vaginal dilator is a device
used to gradually stretch or widen the vagina.
You can start using a dilator as soon as 2 to 4
weeks after radiation therapy has ended and
can continue to use it for as long as you want.
Vaginal dilators are not one-size-ts-all.
Dierent sizes are available, as are dilator kits
containing dierent size devices. The size of
the dilator can be increased over time as the
vagina lengthens and widens.
Sexual health
Sexual side eects can occur after cervical
cancer treatment, including:
Reduced sex drive (libido)
Vaginal dryness
Pain during sex
Narrowing and shortening of the vagina
(vaginal stenosis)
While it may be uncomfortable to talk about
sexual health, keep in mind that these
side eects are common and can often be
Mental wellness
Expect your care team to ask about
your mental health. If they don’t,
speak up. There are many resources
available that can improve mental
health and wellness for cancer
survivors.
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Survivorship » Late and long-term eects
managed or lessened. Consider seeing a
sexual health therapist. These health care
professionals specialize in helping cancer
survivors and others overcome and manage
sexual side eects of cancer treatment. Many
cancer treatment centers have programs
focused solely on sexual health after cancer
treatment. Ask your doctor about resources
available through your cancer center that can
help minimize the impact of cancer treatment
on your sexual health.
Mental health and wellness
It can be hard to cope with the eects of
cancer and its treatment. Many survivors
report having a lower quality of life after
cancer treatment. Depression, anxiety,
fear of recurrence, and trouble adjusting
to changes in the body are possible. Many
people also have nancial stressors, such as
concerns or hesitation about returning to work
and insurance coverage issues. Personal
relationships, sexuality, and intimacy may also
be aected by a cancer diagnosis or cancer
treatment.
If you are anxious, distressed, depressed, or
are just having trouble coping with life after
cancer, you are not alone. Tell your treatment
team about these symptoms. Expect your
treatment team to ask about your mental
health. If they don’t, speak up. There are many
resources available that can improve mental
health and wellness for cancer survivors.
Social workers at your treatment center are
often excellent resources to help connect you
with mental health and nancial resources.
Weakened bones
Radiation treatment to the pelvis can weaken
bones in the pelvis, putting you at increased
risk of fractures. Your doctor may want to start
monitoring the density of your bones.
Nerve damage
Chemotherapy can damage the sensory
nerves. This is known as neuropathy. The
damage can result in pain, numbness, tingling,
swelling, or muscle weakness in dierent parts
of the body. It often begins in the hands or feet
and gets worse over time. Neuropathic pain is
often described as a shooting or burning pain.
Swelling
Treatment for cervical cancer often involves
removing lymph nodes during surgery. Lymph
may not drain properly after lymph nodes are
removed. This can result in lymphedema.
Lymphedema is swelling caused by a build-up
of lymph uid in tissues. It most often occurs in
the lower body for cervical cancer survivors.
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Survivorship » Healthy habits
Healthy habits
Monitoring for the return of cervical cancer is
important after nishing treatment. But it is also
important to keep up with other aspects of your
health. Steps you can take to help prevent
other health issues and to improve your quality
of life are described next.
Get screened for other types of cancer, such
as breast, skin, and colorectal cancer. Talk to
your primary care doctor about recommended
cancer screening tests for your age and risk
level.
Get other recommended health care such
as blood pressure screening and hepatitis C
screening, and immunizations (such as the u
shot).
Leading a healthy lifestyle includes maintaining
a healthy body weight. Exercising at a
moderate intensity for at least 150 minutes
per week is recommended. Talk to your doctor
before starting a new exercise regimen. Try to
eat a healthy diet that includes lots of plant-
based foods.
Alcohol may increase the risk of certain
cancers. Drink little to no alcohol.
If you smoke, quit! Your doctor can provide
(or refer you for) counseling on how to stop
smoking.
More information
For more information on cancer survivorship,
the following are available at NCCN.org/
patientguidelines and on the NCCN Patient
Guides for Cancer app:
Survivorship Care for Healthy Living
Survivorship Care for Cancer-Related
Late and Long-Term Eects
These resources address topics relevant to
ovarian cancer survivors, including:
Anxiety, depression, and distress
Fatigue
Pain
Sexual health
Sleep problems
Healthy lifestyles
Immunizations
Working, insurance, and disability
concerns
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Survivorship » Key points
Key points
Survivorship focuses on the physical,
emotional, and nancial issues unique to
cancer survivors.
Ask your oncologist (cancer doctor) about
a survivorship care plan. This document
can help your oncologist and PCP
coordinate your follow-up care.
It is important to stay alert for signs of
potential recurrence or spread, including
vaginal discharge or bleeding, blood in
your urine or stool, and weight loss.
Many cervical cancer survivors
experience problems with bowel, urinary,
and sexual function.
Other physical side eects include
infertility, early menopause, fatigue,
trouble breathing, insomnia, painful nerve
damage, and swelling of the legs.
Pelvic oor physical therapy, hormone
replacement therapy, and vaginal
moisturizers and dilators can help with
some side eects.
Sexual health therapists specialize in
helping cancer survivors and others
overcome and manage sexual side
eects of cancer treatment.
Depression, anxiety, fear of recurrence,
and trouble adjusting to changes in the
body are possible after cervical cancer
treatment.
Talk to your treatment team about
resources that can improve mental health
and wellness for cancer survivors.
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Making treatment decisions » It’s your choice
It is important to be comfortable
with the cancer treatment you
choose. This choice starts with
having an open and honest
conversation with your care team.
It’s your choice
In shared decision-making, you and your care
team share information, discuss the options,
and agree on a treatment plan. It starts with an
open and honest conversation between you
and your team.
Treatment decisions are very personal. What
is important to you may not be important to
someone else.
Some things that may play a role in your
decision-making:
What you want and how that might dier
from what others want
Your religious and spiritual beliefs
Your feelings about certain treatments
Your feelings about pain or side eects
Cost of treatment, travel to treatment
centers, and time away from school or
work
Quality of life and length of life
How active you are and the activities that
are important to you
Think about what you want from treatment.
Discuss openly the risks and benets of specic
treatments and procedures. Weigh options and
share concerns with your doctor. If you take the
time to build a relationship with your team, it
will help you feel supported when considering
options and making treatment decisions.
Second opinion
It is normal to want to start treatment as
soon as possible. While cancer should not
be ignored, there is time to have another
cancer care provider review your test results
and suggest a treatment plan. This is called
getting a second opinion, and it’s a normal
part of cancer care. Even doctors get second
opinions!
Things you can do to prepare:
Check with your insurance company
about its rules on second opinions. There
may be out-of-pocket costs to see doctors
who are not part of your insurance plan.
Make plans to have copies of all your
records sent to the doctor you will see for
your second opinion.
Support groups
Many people diagnosed with cancer nd
support groups to be helpful. Support groups
often include people at dierent stages
of treatment. Some people may be newly
diagnosed, while others may be nished with
treatment. If your hospital or community doesn’t
have support groups for people with cancer,
check out the websites listed in this book.
Questions to ask
Possible questions to ask your cancer care
team are listed on the following pages. Feel
free to use these or come up with your own.
Be clear about your goals for treatment and
nd out what to expect from treatment.
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Making treatment decisions » Questions to ask
Questions about treatment
1. What treatment plan do you recommend for me?
2. What are the risks and benets of each treatment? What about side eects?
3. Will my age, general health, and other factors aect my treatment options?
4. Would you help me get a second opinion?
5. How soon should I start treatment? How long does treatment take? Is there a clinical
trial that I can join?
6. Where will I be treated? Will I have to stay in the hospital or can I go home after each
treatment?
7. What can I do to prepare for treatment?
8. What symptoms should I look out for during treatment?
9. How much will the treatment cost? How can I nd out how much my insurance company
will cover?
10. Are there supportive services that I can get involved in? Support groups?
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Making treatment decisions » Questions to ask
Questions about recurrence
1. How likely is it that the cancer will return? What is my risk based on?
2. Will I need pelvic exenteration? If so, which organs will be removed?
3. Will I need an ostomy?
4. How likely is the cancer to metastasize? Where does it usually spread?
5. Am I eligible for treatment with a targeted therapy or immunotherapy?
6. What biomarkers does my cancer have?
7. What if the cancer returns a second time?
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Making treatment decisions » Questions to ask
Questions about clinical trials
1. Is a clinical trial right for me?
2. What is the purpose of the study?
3. How many people will be in the clinical trial?
4. What are the tests and treatments for this study? How often will they take place?
5. Has the drug been used before? Has it been used for other types of cancers?
6. What side eects can I expect? Can the side eects be controlled?
7. How long will I be in the clinical trial?
8. How will you know if the treatment is working?
9. Will I be able to get other treatment if this treatment doesn’t work?
10. Who will help me understand the costs of the clinical trial?
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Making treatment decisions » Questions to ask
What is your experience?
1. Are you board-certied? If yes, in what area?
2. How many patients like me have you treated?
3. How many procedures like the one you’re suggesting have you done?
4. Is this treatment a major part of your practice?
5. How many of your patients have had complications?
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Making treatment decisions » Resources
Resources
Cancer Hope Network
cancerhopenetwork.org
Cervivor
cervivor.org
HPV Cancers Alliance
hpvca.org
National Cancer Institute (NCI)
cancer.gov/types/cervical
MSI Insiders
Msiinsiders.org
Ovarian Cancer Research Alliance (OCRA)
Ocrahope.org
Smokefree.gov
smokefree.gov
Triage Cancer
Triagecancer.org
U.S. National Library of Medicine Clinical
Trials Database
clinicaltrials.gov
Take our survey,
and help make the
NCCN Guidelines for Patients
better for everyone!
NCCN.org/patients/comments
share with us.
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Ü
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NCCN Guidelines for Patients®
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Words to know
Words to know
abdomen
The belly area between the chest and pelvis.
adenocarcinoma
Cervical cancer that starts in glandular cells
in the endocervix. About 2 out of 10 cervical
cancers are adenocarcinomas.
adenosquamous carcinoma
A less common type of cervical cancer that
contains both squamous cells and gland-like
cells.
biomarkers
Specic features of cancer cells. Biomarkers
can include proteins made in response to the
cancer and changes (mutations) in the DNA of
cancer cells.
brachytherapy
A type of radiation therapy in which radioactive
material sealed in needles, seeds, wires,
or catheters is placed directly into or near a
tumor. Also called internal radiation therapy.
cancer grade
A rating of how abnormal cancer cells look
when viewed under a microscope.
cancer stage
A rating of the extent of cancer in the body.
cervical intraepithelial neoplasia (CIN)
Abnormal and potentially pre-cancerous
cells on the surface of the cervix. Also called
cervical dysplasia.
cervix
The lower part of the uterus that connects to
the vagina.
clinical trial
A type of research involving people that
assesses investigational treatments.
cone biopsy
A procedure in which a cone-shaped piece of
abnormal tissue is removed from the cervix.
May be used to gather more information about
the extent of a cancer or to treat some early
cervical cancers.
ectocervix
The rounded, outer part of the cervix that
extends into the vagina. The ectocervix is lined
with cells called squamous cells.
endocervix
The inner part of the cervix that forms a canal
between the vagina and the uterus. The
endocervix is lined with columnar (glandular)
cells that make mucus.
external beam radiation therapy (EBRT)
Treatment with radiation received from a large
machine outside the body. Types of EBRT
include intensity-modulated radiation therapy
(IMRT) and stereotactic body radiation therapy
(SBRT).
extrafascial hysterectomy
Surgery to remove the uterus (including the
cervix). The vagina is not removed. The
connective tissue and fat surrounding the
cervix is not removed. Also called simple
hysterectomy.
fallopian tube
A thin tube through which an egg travels from
the ovary to the uterus.
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Words to know
gynecologic oncologist
A surgeon who is an expert in cancers that
start in the female reproductive organs.
human papillomavirus (HPV)
A common sexually transmitted infection.
Almost all cervical cancers are caused by long-
term HPV infection.
infusion
A method of giving drugs slowly through a
needle into a vein.
lymph
A clear uid containing white blood cells that
ght infection and disease.
lymph nodes
Small groups of disease-ghting cells located
throughout the body.
lymphovascular space invasion (LVSI)
The presence of tumor cells in the blood
vessels or lymph vessels inside the tumor.
LVSI is a risk factor for cancer spread.
medical oncologist
A doctor who is an expert in treating
cancer with systemic therapies, such as
chemotherapy.
menopause
The point in time when menstrual periods end.
metastasis
The spread of cancer cells from the rst tumor
to another body part.
modied radical hysterectomy
Surgery to remove the uterus (including the
cervix). A half inch or less of the vagina is also
removed. Some of the connective tissue and
fat surrounding the cervix is also removed.
mutation
A change in the DNA sequence of a cell.
Mutations may be inherited, random, or
caused by DNA-damaging sources in the
environment. Some mutations are biomarkers
(features) that may guide cancer treatment.
neuroendocrine carcinoma of the cervix
(NECC)
A rare and often aggressive subtype of cervical
cancer.
neuropathy
A nerve problem that causes pain, tingling, and
numbness in the hands and feet.
oophoropexy
Surgery that moves one or both ovaries out of
the range of the radiation beam. Also called
ovarian transposition.
ovary
One of a pair of organs that make hormones
and eggs for sexual reproduction.
parametrium
The fat and connective tissue surrounding the
uterus. The parametrium helps connect the
uterus to other tissues in the pelvis.
pathologist
An expert in testing cells and tissue to nd
disease.
pelvic exam
A physical exam of the external genitalia,
vagina, cervix, uterus, fallopian tubes, and
ovaries.
pelvic exenteration
A radical surgery used to treat cervical cancer
that returns to the pelvis. The uterus (including
the cervix), vagina, ovaries, and fallopian tubes
are removed. The bladder, rectum, and/or
anus may also be removed.
pelvis
The area of the body between the hip bones.
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Words to know
platinum-based chemotherapy
Treatment with two or more chemotherapy
drugs and the main drug is made with
platinum.
radiation oncologist
A doctor who is an expert in treating cancer
with radiotherapy.
radical hysterectomy
Surgery to remove the uterus (including
the cervix) and the top quarter or third of
the vagina. The connective tissue and fat
surrounding the cervix is also removed.
radiologist
A doctor who is an expert in interpreting
imaging tests.
recurrence
The return of cancer after treatment. Also
called a relapse.
reproductive system
The group of organs that work together for
sexual reproduction. The female reproductive
system includes the ovaries, fallopian tubes,
uterus, cervix, and vagina.
squamo-columnar junction
The area where the endocervix and ectocervix
meet. Also called the transformation zone.
Most cervical cancers and pre-cancers start in
the squamo-columnar junction.
squamous cell carcinoma
Cancer that starts in squamous cells lining the
ectocervix. The most common type of cervical
cancer.
supportive care
Treatment given to relieve the symptoms of a
disease. Also called palliative care.
surgical menopause
The stopping of menstrual periods caused by
surgery to remove the ovaries.
targeted therapy
Treatment with drugs that target a specic or
unique feature of cancer cells.
trachelectomy
Surgery to remove the cervix. The upper part
of the vagina and certain pelvic lymph nodes
may also be removed.
uterus
The organ where a fetus grows and develops
during pregnancy. Also called the womb.
vagina
The hollow, muscular tube through which
babies are born. Also called the birth canal.
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NCCN Contributors
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cervical Cancer, Version 1.2024 were
developed by the following NCCN Panel Members:
Nadeem R. Abu-Rustum, MD/Chair
Memorial Sloan Kettering Cancer Center
Catheryn M. Yashar, MD/Vice Chair
UC San Diego Moores Cancer Center
Rebecca Arend, MD
O'Neal Comprehensive
Cancer Center at UAB
Emma Barber, MD
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
*Kristin Bradley, MD
University of Wisconsin
Carbone Cancer Center
Rebecca Brooks, MD
UC Davis Comprehensive Cancer Center
Susana M. Campos, MD, MPH, MS
Dana-Farber/Brigham and Women’s
Cancer Center
Junzo Chino, MD
Duke Cancer Institute
Hye Sook Chon, MD
Mott Cancer Center
Marta Ann Crispens, MD
Vanderbilt-Ingram Cancer Center
Shari Damast, MD
Yale Cancer Center/Smilow Cancer Hospital
Christine M. Fisher, MD, MPH
University of Colorado Cancer Center
Peter Frederick, MD
Roswell Park Cancer Institute
David K. Ganey, MD, PhD
Huntsman Cancer Institute
at the University of Utah
Stephanie Gaillard, MD, PhD
The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins
Robert Giuntoli II, MD
Abramson Cancer Center
at the University of Pennsylvania
Scott Glaser, MD, PhD
City of Hope National Medical Center
Jordan Holmes, MD, MPH
Indiana University Melvin and Bren Simon
Comprehensive Cancer Center
Brooke E. Howitt, MD
Stanford Cancer Institute
Jayanthi Lea, MD
UT Southwestern Simmons
Comprehensive Cancer Center
Gina Mantia-Smaldone
Fox Chase Cancer Center
Andrea Mariani, MD
Mayo Clinic Comprehensive Cancer Center
David Mutch, MD
Siteman Cancer Center at Barnes-
Jewish Hospital and Washington
University School of Medicine
Christa Nagel, MD
The Ohio State University Comprehensive
Cancer Center - James Cancer Hospital
and Solove Research Institute
*Larissa Nekhlyudov, MD, MPH
Dana-Farber/Brigham and Women’s
Cancer Center
Mirna Podoll, MD
Vanderbilt-Ingram Cancer Center
Kerry Rodabaugh MD
Fred & Pamela Buett Cancer Center
Ritu Salani, MD, MBA
UCLA Jonsson
Comprehensive Cancer Center
John Schorge, MD
St. Jude Children's Research Hospital/
The University of Tennessee Health
Science Center
Jean Siedel, DO, MS
University of Michigan Rogel Cancer Center
Rachel Sisodia, MD
Mass General Cancer Center
*Pamela Soliman, MD, MPH
The University of Texas
MD Anderson Cancer Center
Stefanie Ueda, MD
UCSF Helen Diller Family
Comprehensive Cancer Center
Renata Urban, MD
Fred Hutchinson Cancer Center
Stephanie L. Wethington, MD, MSc
The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins
*Emily Wyse
Patient Advocate
Kristine Zanotti, MD
Case Comprehensive Cancer Center/
University Hospitals Seidman Cancer
Center and Cleveland Clinic Taussig
Cancer Institute
NCCN Sta
Shaili Aggarwal, PhD
Oncology Scientist/Medical Writer
Nicole McMillian, MS
Senior Guidelines Coordinator
NCCN Contributors
This patient guide is based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cervical
Cancer, Version 1.2024. It was adapted, reviewed, and published with help from the following people:
Dorothy A. Shead, MS
Senior Director
Patient Information Operations
Erin Vidic, MA
Senior Medical Writer, Patient Information
Susan Kidney
Senior Graphic Design Specialist
* Reviewed this patient guide. For disclosures, visit NCCN.org/disclosures.
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NCCN Cancer Centers
NCCN Cancer Centers
Abramson Cancer Center
at the University of Pennsylvania
Philadelphia, Pennsylvania
800.789.7366 • pennmedicine.org/cancer
Case Comprehensive Cancer Center/
University Hospitals Seidman Cancer Center and
Cleveland Clinic Taussig Cancer Institute
Cleveland, Ohio
UH Seidman Cancer Center
800.641.2422 • uhhospitals.org/services/cancer-services
CC Taussig Cancer Institute
866.223.8100 • my.clevelandclinic.org/departments/cancer
Case CCC
216.844.8797 • case.edu/cancer
City of Hope National Medical Center
Duarte, California
800.826.4673 • cityofhope.org
Dana-Farber/Brigham and Women’s Cancer Center |
Mass General Cancer Center
Boston, Massachusetts
617.732.5500 • youhaveus.org
617.726.5130 • massgeneral.org/cancer-center
Duke Cancer Institute
Durham, North Carolina
888.275.3853 • dukecancerinstitute.org
Fox Chase Cancer Center
Philadelphia, Pennsylvania
888.369.2427 • foxchase.org
Fred & Pamela Buett Cancer Center
Omaha, Nebraska
402.559.5600 • unmc.edu/cancercenter
Fred Hutchinson Cancer Center
Seattle, Washington
206.667.5000 • fredhutch.org
Huntsman Cancer Institute at the University of Utah
Salt Lake City, Utah
800.824.2073 • healthcare.utah.edu/huntsmancancerinstitute
Indiana University Melvin and Bren Simon
Comprehensive Cancer Center
Indianapolis, Indiana
888.600.4822 • www.cancer.iu.edu
Mayo Clinic Comprehensive Cancer Center
Phoenix/Scottsdale, Arizona
Jacksonville, Florida
Rochester, Minnesota
480.301.8000 • Arizona
904.953.0853 • Florida
507.538.3270 • Minnesota
mayoclinic.org/cancercenter
Memorial Sloan Kettering Cancer Center
New York, New York
800.525.2225 • mskcc.org
Mott Cancer Center
Tampa, Florida
888.663.3488 • moffitt.org
O’Neal Comprehensive Cancer Center at UAB
Birmingham, Alabama
800.822.0933 • uab.edu/onealcancercenter
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
Chicago, Illinois
866.587.4322 • cancer.northwestern.edu
Roswell Park Comprehensive Cancer Center
Bualo, New York
877.275.7724 • roswellpark.org
Siteman Cancer Center at Barnes-Jewish Hospital
and Washington University School of Medicine
St. Louis, Missouri
800.600.3606 • siteman.wustl.edu
St. Jude Children’s Research Hospital/
The University of Tennessee Health Science Center
Memphis, Tennessee
866.278.5833 • stjude.org
901.448.5500 • uthsc.edu
Stanford Cancer Institute
Stanford, California
877.668.7535 • cancer.stanford.edu
The Ohio State University Comprehensive Cancer Center -
James Cancer Hospital and Solove Research Institute
Columbus, Ohio
800.293.5066 • cancer.osu.edu
The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins
Baltimore, Maryland
410.955.8964
www.hopkinskimmelcancercenter.org
The UChicago Medicine Comprehensive Cancer Center
Chicago, Illinois
773.702.1000 • uchicagomedicine.org/cancer
The University of Texas MD Anderson Cancer Center
Houston, Texas
844.269.5922 • mdanderson.org
UC Davis Comprehensive Cancer Center
Sacramento, California
916.734.5959 • 800.770.9261
health.ucdavis.edu/cancer
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NCCN Cancer Centers
UC San Diego Moores Cancer Center
La Jolla, California
858.822.6100 • cancer.ucsd.edu
UCLA Jonsson Comprehensive Cancer Center
Los Angeles, California
310.825.5268 • cancer.ucla.edu
UCSF Helen Diller Family
Comprehensive Cancer Center
San Francisco, California
800.689.8273 • cancer.ucsf.edu
University of Colorado Cancer Center
Aurora, Colorado
720.848.0300 • coloradocancercenter.org
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan
800.865.1125 • rogelcancercenter.org
University of Wisconsin Carbone Cancer Center
Madison, Wisconsin
608.265.1700 • uwhealth.org/cancer
UT Southwestern Simmons
Comprehensive Cancer Center
Dallas, Texas
214.648.3111 • utsouthwestern.edu/simmons
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee
877.936.8422 • vicc.org
Yale Cancer Center/Smilow Cancer Hospital
New Haven, Connecticut
855.4.SMILOW • yalecancercenter.org
79
NCCN Guidelines for Patients®
Cervical Cancer, 2024
Notes
Notes
80
NCCN Guidelines for Patients®
Cervical Cancer, 2024
Index
Index
biomarker 37, 48–49, 51–52
cervical dysplasia 7
chemoradiation 35, 37, 42–47, 55–56
clinical trial 28, 38–39, 48, 53, 56
fertility-sparing treatment 16, 32, 42–43
HER2 49, 52
human immunodeciency virus (HIV) 8, 13
human papillomavirus (HPV) 5, 8
immunotherapy 37, 51–52
microsatellite instability (MSI) 49, 52
mismatch repair (MMR) 49, 52
NECC 9, 15, 47, 54–57
NTRK gene fusion 49, 52
ovarian transposition 16, 35
PD-L1 48–49, 51–52
premature menopause 33–35, 60
RET gene fusion 49, 52
sexual health 61–63
stereotactic body radiation therapy (SBRT)
34, 51
supportive care 28, 53, 56
surrogacy 16
survivorship 48, 58–63
tumor mutational burden (TMB) 49, 52
Ü
